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AAA-The Auto Club Group · 2 days ago

Medicare Compliance Analyst (Florida)

Florida, United States

Full-time

Hybrid

Entry, Mid Level

$21.35/hr - $25/hr

AAA The Auto Club Group is seeking a Medicare Compliance Analyst to join their team. In this role, you will analyze claims, process reimbursement requests, and serve as a liaison between customers and providers to resolve billing issues.

Insurance

Responsibilities

Refer callers to appropriate individuals for additional information as needed

May represent company at trials, depositions and settlement hearings

Review claim information to determine if ACG has an exposure of ORM

Process Medicare Advantage requests for reimbursement

Identify proper data if claim qualifies for reporting, if not remove from reporting

Report appropriate claims

Determine validity of CMS liens

For all Medical related areas:

Act as a liaison between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to providers, etc

Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable

Qualification

Claim analysisMedical bill reviewMedical terminologyCPTICD-9Automated processing systemsNegotiatingOrganizationPlanningAnalyzingNegligence lawNo-fault lawInsurance actsProblem solvingWritten communicationsDecision makingCommunication skills

Required

College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience

Claim analysis, or similar function

Medical bill review (cost containment) operating a personal computer

Utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.)

Knowledge of one or more of the following: Medical terminology and human anatomy, CPT, ICD-9 and 10 and revenue codes (MBRU), Property and casualty claims process and procedures, FACTS, IPM and CPS'

Ability to use automated processing systems

Ability to effectively respond to questions/concerns

Ability to communicate effectively with others in a work environment, with the Public and vendors

Ability to independently perform detailed, complex medical bill or similar analysis

Demonstrated skill in organization and planning

Demonstrated skill in analyzing and problem solving

Demonstrated skill in written communications to include record keeping and report preparation

Demonstrated skill in decision making

Demonstrated skill in negotiating