Hybrid Medicare Compliance Claim Analyst

at AAA

• Job title: Medicare Compliance Claim Analyst
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $24 - $28 per hour
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Dearborn, United States

About the role

• Claim Analyst managing Medicare compliance claims for The Auto Club Group in a hybrid work environment. Performing duties related to claim processing and liaison activities with customers and providers.

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.
• 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

Requirements

• 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 Effectively respond to questions/concerns Communicate effectively with others in a work environment, with the Public and vendors Independently perform detailed, complex medical bill or similar analysis Demonstrated skill in: Organization and planning Analyzing and problem solving Written communications to include record keeping and report preparation Decision making Negotiating

Benefits

• Medical, dental and vision benefits
• 401k Match
• Paid parental leave and adoption assistance
• Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
• Paid volunteer day annually
• Tuition assistance program, professional certification reimbursement program and other professional development opportunities
• AAA Membership Discounts, perks, rewards, and much more