Michigan Medicare Compliance Claim Analyst

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Job Type:

Job Description:

Position Description:

Primary Duties and Responsibilities (details of the basic job functions):

The Auto Club Group is seeking a prospective Michigan Medicare Compliance Claims Analyst who will use Web Based and other applications to bill, document or analyze work. Refer callers to appropriate individuals for additional information as needed. May represent company at trials, depositions and settlement hearings. Audit medical billing charges to ensure treatment is consistent with claim related injuries. Review medical reports, health insurance explanation of benefits, loss reports, etc. to obtain additional information and ensure appropriateness of treatment/charges. Communicate with claim representatives and/or medical specialists to discuss medical billing practices. Approve reasonable and customary payments in accordance with corporate guidelines and documents payment/rejection information in Mitchell Medical diary to monitor expenditures, ensure coordination of benefits and avoid duplicate payments. 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.

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. For all Medical related areas: 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.

Required Qualifications (these are the minimum requirements to qualify)

Education:

• College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience

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 and Skills:

Knowledge of one or more of the following:

• medical terminology and human anatomy

• CPT, ICD-9 and 10 and revenue codes (MBRU)

• Property and casualty claim process and procedures

• FACTS, IPM and CPS'

Ability to:

• use automated processing systems

• effectively respond to questions/concerns

• communicate effectively with others in a work environment, with the Public and vendors

• independently perform detailed, complex medical bill or similar analysis

Demonstrated skill in:

• organization and planning

• analyzing and problem solving

• written communications to include record keeping and report preparation

• decision making

• negotiating

Preferred Qualifications:

Education:

• Associate's degree in Business Administration, Insurance or a related field.

Experience:

• Processing or working within a medical claims environment
• Medical billing experience with both Medicare and Medicaid
• Exposure to processing or working with VA (Veteran Affairs) claims
• Working within a heavy team environment
• Performing both inbound and outbound calling to internal and external clients

The ability to:

• Communicate proficiently both orally and written

• Remain organized and work on multiple tasks simultaneously and efficiently

• Work independently on a remote basis and be self-sufficient within a professional setting

Work Environment

• This is a hybrid work arrangement (time spent in office and remote). Depending on the employee's role and leadership's assessment, some employees will come into an ACG facility on a weekly basis, a monthly basis, or on an "as needed" basis for key meetings and collaborative activities. Most employees will be required to come into the office, at a minimum, for important departmental meetings or teambuilding events.

For this opening, employees will perform daily work duties on a remote basis with any needed in office visits outlined by management. This position will be required to report in office as outlined by the management team at minimum for team meetings and specific assignments. Candidates must reside within the state of Michigan for hybrid purposes.

With our powerful brand and the mentoring we offer, you will find that your position as aMichigan Medicare Compliance Claims Analyst can lead to a rewarding career at our growing organization.

How you will benefit:

The Michigan Medicare Compliance Claims Analyst will earn a competitive salary of $21.00 - $25.00 an hour with an annual bonus potential based on performance.

• Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:

• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com