Claims Reviewer
*This is a hybrid position
*This is a 6 month contract position
Description:
- The Claims Reviewer will be responsible for the completion of audits of many different provider types, including home and community based service (HCBS) providers, physicians and other practitioners, applied behavior analysis (ABA) providers, and other mental health related services providers.
- The objective of these audits is to evaluate Medicaid claims for compliance with Medicaid regulations and policy.
Responsibilities:
- Work with Management to ensure all internal and regulatory deadlines are met
- Strive to exceed client expectations
- Research and apply Federal and State Medicaid policies and regulations
- Maintain status logs of assigned jobs
- Effectively communicate with stakeholders, including client staff and provider staff
- Maintain security and confidentiality of all protected health information
- Prepare and review audit workpapers in accordance with firm and professional standards
- Prepare and distribute analytical data reports and/or records
- Work with the defined scope of the project
- Work on multiple assignments with strict deadlines
- Mentor, train and provide assistance to other team members
- Additional responsibilities as assigned
Required Skills/Knowledge/Experience:
- Bachelor’s degree required
- 2 years of relevant experience, preferably reviewing Medicaid claims
- Proficient use of applicable software programs, including Microsoft Word, Excel, Windows
- Knowledge of third party reimbursement rules and regulations, and an ability understand Medicaid policies and regulations
- Experience in training, supervising, and coordinating the work of others
- Organized and detail oriented with strong problem solving skills
- Self-starter with the ability to work accurately and independently
- Demonstrated ability to effectively communicate verbally and in writing with all levels of an organization, both internally and externally
- Effectively multi-task with planning and efficiency
- Must be able to manage multiple deadlines and prioritize assignments
- Ability to work in a team environment
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