AM/Manager - Workers Compensation Audit - US Healthcare Payer Claims (5-10 yrs)Role Overview:- Good understanding of US Healthcare Payer Claims- Experience in audit of workers compensation medical bills- Strong understanding of CMS State payment policies- Expert in State Fee Schedules and payment hierarchy- Good analytical and communication skillsResponsibilities:- Serve as subject matter expert and analyze claims payments as per state workers compensation guidelines- Quality audit of workers compensation medical bill payments- Responsible for the accurate and thorough investigation of potential fraud and abuse involving workers compensation- Provide ideas to technical team of potential overpayment cases- Documentation of provider communication- Proactively gather feedback from users- Quick turnaround using logical understanding of data- Tracking and reporting of assigned tasks for internal and external stakeholdersCandidate Profile:- Candidates with 7 years of US healthcare claims experience- Experience in audit of workers compensation medical bills payment- Knowledge of CPT, Modifiers, ICD-10, DRG, Revenue codes and preauthorization guidelines- Comprehensive knowledge on health care industry, medical bills processing, AR and payment posting cycle- Thorough knowledge of payment rules hierarchy, fee schedule configuration and their impact on payment- Capability to provide inputs to technical team with potential cases of overpayment in Institutional and Professional medical bills- Preferred experience in data mining techniques using SAS/SQL/R or other similar language- Superior skills to effectively communicate and negotiate across the business and external health care environment- Demonstrate ability to interact effectively with non-technical clients and internal teams- Must be a dependable and reliable player, able to work independently and as part of a goal oriented team with a positive attitude- Must have strong analytical, reasoning, organizational and management skills
Job Type : full-time
Experience : 5 - 10Years
Company : HUQUO CONSULTING PVT. LTD.
Industry : Consumer Durables/ Semi Durables