Medical Claims Resolution Specialist en Asset Protection Unit Inc

Description

Summary/Objective 

Asset Protection Unit Inc. seeks a detail-oriented Medical Claims Resolution Specialist to join our team. You will be responsible for resolving all billing issues, claim appeals, respond to disputes from medical providers, and provide internal program concept suggestions. This is a great opportunity for someone who enjoys problem solving, working collaboratively, and contributing to a high performing audit team.

Essential Functions

• Examine medical claims by reviewing EOBs, CPT procedures, fee schedules, and other documentation
• Process appeals and reconsiderations for denial claims
• Accurately review and resolve all medical claim appeals/disputes and respond to medical providers in a timely manner
• Research medical claim documentation
• Communicate with internal team members and external providers regarding medical claims, appeals and overpayments
• Understanding of CPT, ICD-10 coding as well as NCDs, LCDs, CCI Edits
• Investigate claim data to provide feedback, propose concept ideas to identify overpayment opportunities 
• Research rejections included in EOBs for resolution and files appropriately
• Identify and research frequent causes of denials so corrective action plans can be implemented
• Collaborate with internal staff to address discrepancies or issues
• Meets established daily, weekly and monthly deadlines
• Strong understanding of physiology, medical terms and anatomy 
• Ensure compliance with regulatory standards 
• Maintain policies, procedures, and training guides
• Complete other duties, as assigned

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies

• Ability to perform the essential job functions
• Education and experience
• Professionalism
• Problem Solving/Analysis
• Attention to Detail

Supervisory Responsibility

This position has no supervisory responsibilities

Required Education and Experience

• High school diploma or equivalent required.
• Certified Professional Coder
• Minimum 2 years of medical billing and coding experience required
• Experience in processing Medicare/Medicaid billing or auditing is required.
• Strong interpersonal skills, oral and written communication skills.
• Be able to work independently.
• Must be able to focus on the task at hand for an entire day.
• Be detail oriented, accurate, efficient, and precise in completing the tasks associated with the position.

Preferred Education and Experience

• Post high school education or certification is preferred.
• Proficiency with technology, especially computers and software applications. Have intermediate knowledge of Microsoft Excel and Word. Mainframe, “green screen” experience is preferred.
• Two years or more of experience with insurance claims examination or processing is highly preferred.

Eligibility Qualifications

• Passing of skill test will be required.
• Intermediate Windows & MS Office Skills are mandatory.
• To be considered for this role, please complete the Predictive Index Assessment at: https://assess.predictiveindex.com/eArRQ.
• Must attend all days of onboarding training. If unable to attend all days of the training which are held in the first 30 days, the applicant will be rescheduled for the next available training. If unable to attend all days of the rescheduled training, the employee will be released from employment.

Internal Candidate Eligibility Qualifications

• Minimum 3 years’ APU experience 
• Certified Professional Coder
• Coding experience required 
• Cannot have any written warnings or performance improvement plans currently in place.
• Proven problem solving, attention to detail, and meeting deadlines in an APU role as documented by their department director and/or performance evaluations.

Work Authorization

Candidates selected will be subject to a pre-employment background investigation (drug test, credit check, reference verification) and skills test.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. 

Compensation and Benefits

There will be an attractive compensation package that is commensurate with experience. APU offers a full suite of benefits for full-time employees. Those benefits include medical, dental, vision, life, LTD, 401k, PTO and holiday pay. Join our growing team based exclusively in Amarillo, Texas.

Position Type/Expected Hours of Work 

This is a full-time position. Days and hours of work are Monday through Friday, 8 a.m. to 5 p.m. This position requires 40 hours per week with some time outside of normal hours.

Travel

No travel is expected for this position.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee will be required to sit for extended periods of time and is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

• This position requires sitting over 66% of the time.
• This position requires Visual Acuity at 20 inches (or less) over 66% of the time.

AAP/EEO Statement 

APU is an affirmative action/equal opportunity employer (AA/EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, sexual orientation, disability status, genetic information, protected veteran status or any other characteristic protected by federal, state or local law. 

Requirements

High school diploma or equivalent required.

Certified Professional Coder

Minimum 2 years of medical billing and coding experience required

Experience in processing Medicare/Medicaid billing or auditing is required.

Strong interpersonal skills, oral and written communication skills.

Be able to work independently.

Must be able to focus on the task at hand for an entire day.

Be detail oriented, accurate, efficient, and precise in completing the tasks associated with the position.