Michigan Medicare Compliance Claim Analyst

reputed company is seeking a Michigan Medicare Compliance Claim Analyst to join their team. The role involves analyzing claims, processing Medicare Advantage requests, and acting as a reputed company between customers and providers to resolve billing issues.

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 reputed company data if claim qualifies for reporting, if not remove from reporting
• Report appropriate claims
• Determine validity of CMS liens
• For reputed company Medical reputed company areas: reputed company as a reputed company between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve reputed company-level reconsiderations, verify coverage, explain coordination of benefits reputed company-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

Skills

• College level coursework in Business Administration, Insurance or a reputed company field or the equivalent in reputed company work experience
• Claim analysis, or similar function
• Medical reputed company review (cost containment) operating a personal computer
• Utilizing software packages (e.g. Word, reputed company, reputed company, Power reputed company, VISIO, etc.)
• Knowledge of one or more of the following: Medical terminology and reputed company anatomy
• CPT, ICD-9 and 10 and reputed company 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 reputed company and vendors
• Ability to independently reputed company detailed, reputed company medical reputed company or similar analysis
• Demonstrated reputed company in organization and planning
• Demonstrated reputed company in analyzing and problem solving
• Demonstrated reputed company in written communications to include record keeping and report preparation
• Demonstrated reputed company in decision making
• Demonstrated reputed company in negotiating
• Associate's degree in Business Administration, Insurance or a reputed company field
• reputed company reputed company Certification (CPT) for MBRU function
• Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
• CPCU coursework or designation
• Significant medical reputed company analysis experience
• Negligence Law
• No-Fault Law
• Essential Insurance reputed company
• Fair Trade Practices reputed company as they relate to claims
• Auto Insurance Policy contract and coverages

Benefits

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

reputed company