Plymouth, Michigan
Healthcare Claims Audit Analyst Job Opening in Plymouth, Michigan - Company Description
Health Decisions, Inc. is a national leader in the design and delivery of specialized Comprehensive Medical and Eligibility audits for employers. Health Decisions has over 30 years? experience designing systems to efficiently mine large medical claims and eligibility databases. Our company?s growth has prompted us to seek a talented professional to join our team. The company is located in the community of Plymouth, Michigan.
Position Summary
Lead analyst in the review of medical, dental, vision claims, and eligibility data.
Analysis of third-party liability, subrogation, member eligibility; provider billing practices, and claims administrative practices.
Ability to examine case level diagnosis, and procedure information.
Ability to determine if the claimant was eligible for coverage based on the data presented.
Ability to analyze health financial data, payment practices and interpret results.
Review system reports, interpret the findings and write the Final Audit Report.
Provides lead client support throughout the audit steps including: project launch; data request; prepare periodic status reports; preparing final report; and reviewing carrier status of finding.
Experience in attending Site Visits at payer offices such as Aetna, Cigna, and United Health Care, to review sample findings.
Skills and Attributes
Demonstrated ability to create new or modify reports and documents in Microsoft Word and Excel. Knowledge of Microsoft Access a plus.
Effective written and oral communications.
Familiarity with ICD ? 10 ? CM and CPT coding. Understanding Medicare reimbursement rules. Familiar with Employer Summary Plan Descriptions and plan provisions.
The successful candidate should possess ability to work as part of a team.
Qualifications and Work Experience
3-5 years? experience in medical claim analysis.
Proficient in Microsoft Excel and Word.
Familiarity with medical claim processing a plus.
College degree - healthcare related.
Salary commensurate with experience.
Work Environment
Health Decisions is dedicated to fostering growth in their employees. We are a smaller, family-oriented company that values work-life balance.
Job Type: Full-time
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