Michigan Medicare Compliance Claim Analyst
AAA The Auto Club Group is seeking a Michigan Medicare Compliance Claim Analyst who will utilize web-based applications to analyze and process claims. The role involves reviewing claims, determining exposure, and acting as a liaison between customers and providers to ensure proper billing and reimbursement processes.
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
Skills
- 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
- Knowledge of one or more of the following: CPT, ICD-9 and 10 and revenue codes (MBRU)
- Knowledge of one or more of the following: Property and casualty claims process and procedures
- Knowledge of one or more of the following: 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
- Associate's degree in Business Administration, Insurance or a related field
- Professional Coder 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 bill analysis experience
- Knowledge of Negligence Law
- Knowledge of No-Fault Law
- Knowledge of Essential Insurance Act
- Knowledge of Fair Trade Practices Act as they relate to claims
- Knowledge of Auto Insurance Policy contract and coverages
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
Company Overview