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Claims Quality/Audit Exp.

WFH, WFM
Role: Claims Quality/Audit Exp.
Location: Remote Till COVID
Duration: 11+ Months

Job Description


We are specifically looking for associates with Medicaid experience and quality/audit experience
  • Analyze trends in claims processing issues and identify work process solutions
  • Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.
  • Audit check run and send claims to the claims department for corrections
  • Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
  • Collaborate with the claims department to price pended claims correctly
  • Document, track and resolve all plan providers’ claims projects
  • Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
  • Identify authorization issues and trends and research for potential configuration related work process changes
  • Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
  • Identify potential and documented eligibility issues and notify applicable departments to resolve
  • Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.



Regards,

Rahul Yadav
(408) 560-3956
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)

 
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ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)

 

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