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Job Status:
Full Time
Work Experience Required:
Hours/Shifts:
Day (First Shift)
Education Required:
High School Diploma
Certification Required:
Unspecified
Weekends:
Not Required
Authorized to work in US:
Yes
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Salary Range:
Unspecified
Benefits:
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COB Claims Representative - TN-314367
UnitedHealth Group
Description
Ingenix is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.
We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.
As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.
AIM Healthcare, a division of Ingenix, exists to reduce the cost of healthcare and simplify healthcare information management. By developing and supporting technology platforms to analyze data and facilitate connections between payers and providers, AIM specializes in the reduction of healthcare costs in the public and private sectors by identifying, validating, recovering, and preventing errant claims.
Position Summary
The primary role of the Claims Analyst is to review, identify and validate claim overpayments. Types of overpayment reviews will include, but are not limited to:
· Duplicate Payments
· Contract Compliance
· Authorizations
· Eligibility
· Coordination of Benefits
· Medical Review
Minimum Requirements
To perform the job successfully, an individual must be able to perform each essential job function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required to perform the essential job functions.
Essential Job Functions
Production:
· Work with team members to ensure project goals are met in an efficient and effective manner
· Achievement of individual productivity and quality standards
· Record productivity using Daily Production Report. Turn into Management as requested
· Communicate to Management any issue(s) that would impede the accurate and timely review of claims. Work with Management to ensure that these issues are resolved.
· Give feedback to Management regarding query effectiveness and new query ideas
· Record query effectiveness and refund ration on client action plan
Review, Identification, Validation, and Research:
· Acquire knowledge of the client's claims adjudication system, provider contracts as well as basic client claim payment policies and procedures. Communicate with Management issues that may effect the review of claims.
· Communicate any discrepancies of the client's data as loaded into Data Mining internal system.
· Validate claims to ensure the accuracy of query results and that no refund has previously been posted to clients' systems.
· Work with Management on clarification of matters as they arise through the course of review.
· Inform Manager of trends discovered in the review and validation process.
· Contact appropriate parties to confirm that a valid claim has been identified. This could include but not limited to Providers, Members and/or Other Health Insurance Carriers.
· May work with Accounts Receivable staff to research and/or answer questions from providers regarding overpayments.
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.
Qualifications
Education/Experience
High school degree or equivalent required. College degree is strongly preferred. Previous medical claims auditing experience is preferred, along with basic healthcare terminology.
Knowledge/Skills/Ability
Must have demonstrated competency and proficiency in the use of Excel software. Demonstrated effective organizational skills. Continuously conducts complex interpersonal interactions, makes moderately complex decisions, analyzes and solves complex problems, and handles multiple tasks. Frequently uses teamwork skills, discretion, and occasionally mentors/trains new employees.
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