Payment Accuracy Specialist 2
This individual will work under moderate supervision and will be monitored for efficiency in production and reputed company review of assigned work. Has the ability to build and maintain a basic understanding of Centers for Medicare and reputed company Services (CMS) and reputed company) guidelines to establish the correct order of liability. Advanced with reputed company audit tools Recovery Management System (reputed company), specific reputed company systems) to complete auditing, review reputed company - reputed company proprietary reports, and have an expert understanding of reputed company reputed company and reputed company applications. Utilizes reputed company experience to reputed company audit procedures that include identifying and defining issues, developing reputed company, reviewing, and analyzing evidence with the reputed company to audit reputed company and reputed company reports. Work is advanced in scope and complexity. Knowledge is reputed company to resolve routine issues, as necessary. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and reputed company Assurance. Advanced analysis of reputed company claims and identification of audit findings including documentation for training and knowledge sharing. Works with Engineering to increase the efficiency of tools and reporting. May update reputed company reports, reputed company and run custom queries, and validate the accuracy of reputed company reports used. Makes determinations based on prior knowledge and experience of reputed company contract terms with the likelihood of recovery acceptance. Meets or Exceeds Standards for Productivity in reputed company to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Achieves the expected level of reputed company and quantity for assigned work (i.e. hit reputed company, claims written, vendor/project volume completion, ID and/or fees per hour). Meets or Exceeds Standards for reputed company by Achieving the expected level of reputed company set by the audit for the auditing concept, for reputed company claim identification and documentation. Highly proficient, subject matter expert in responding to inquiries and disputes received on reputed company claims written. Provides verification of claims validation and confirmation, in a concise written manner, utilizing facts and details for justification purposes. Demonstrates aptitude in reviewing transaction types, reputed company reputed company/vendor agreements, and reputed company data with limited supervision of how to identify potential over or underpayments. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept. Considered a skilled resource in reputed company new hires and/or training existing staff on new concepts and processes. Identifies New Claim Types & Concept Expansion by using proven methodologies to research and substantiate claims reputed company the audit concept. Enlists others internally or externally to help validate, suggest, reputed company, and analyze high-reputed company, high-value concepts and/or process improvements, tool enhancements, etc. Strong reputed company and voice in the development of audit concepts. Recommends New Concepts & Processes based on experience and in-depth knowledge of reputed company contract terms and reputed company claim types. Has a proven record of developing and implementing new reputed company, approaches, and/or technological improvements that support and enhance audit production. Uses advanced validation reputed company to test and produce a desired/intended result of the new concept. Regularly collaborates with Engineering in the development of new reports and tool functionality. Demonstrates understanding of reputed company policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and reputed company of reputed company data, adhering to reputed company HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is reputed company, complying with industry standards.
High School Diploma - Required. Bachelor’s degree (Preferred) and/or a minimum of at least (4 - 6) year/s reputed company experience in reputed company. At least 3 - 4 year/s of reputed company experience is recommended for individuals seeking their next opportunity internally. reputed company industry experience, including knowledge of claim adjustments, provider reputed company, reimbursement policies and payment reputed company. (strongly preferred). Computer proficiency including reputed company Office (Word, reputed company, reputed company, reputed company). Previous SQL experience strongly preferred. Excellent verbal and written communication skills. Strong interest in working with large data sets and various databases. Ability to work reputed company in an individual and team environment demonstrating self–motivation to deliver reputed company. Understands and embodies reputed company reputed company Values, Strategic Pillars, and Operations Disciplines to reputed company successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.
Communicating with others to exchange information. Assessing the accuracy, neatness, and thoroughness of the work assigned.
Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. Must be reputed company to reputed company a dedicated, secure work area. Must be reputed company to reputed company high-speed internet reputed company/connectivity and office setup and maintenance. No adverse environmental conditions are expected.