4278 Data Process Reviewer

Location: Springfield, IL, United States
Date Posted: 10-13-2017
Role - Data Process Reviewer
Type of Hire - Contract​ (W2)
  • Analyzing federal and state regulations / policies for Medicaid and CHIP reimbursements.
  • Conducts audits to determine if reimbursements to medical providers were in compliance with federal/ state regulations and policies.
  • Conducts second-level reviews of audits made by fellow auditors.
  • Maintains the confidentiality of patient information in accordance with HIPAA regulations.
  • Conducts queries and communicates data findings in written and oral reports as well as presentations.
  • Analyzing federal and state regulations / policies for Medicaid and CHIP reimbursements.
  • Conducts audits to determine if reimbursements to medical providers were in compliance with federal/ state regulations and policies.
  1. Customer Service - Must demonstrate the ability to effectively communicate Medicaid IT related concerns and present outcomes/resolutions.
  2. Claims - Must have a clear understanding of the adjudication process for Illinois Medicaid claims.
  3. BA experience - 3 years of Business Analyst experience preferably in healthcare/Medicaid; able to  absorb complex information. Must be able to digest the material and relay that information to leaders and document business processing requirements.
  4. Credentialing - Must have experience working with providers to ensure they meet state and federal requirements in their designated fields.
If interested pl. send your resume to savitha@reqroute.com
Regards,
Savitha
ReqRoute,Inc
Phone : 408 757 4336 (PST)
email: savitha@reqroute.com
 
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs.  
 
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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