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Analyst, Configuration Oversight (Claims Auditor)
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Job Description
- Req#: 300001462362513
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits and competitive compensation package
- Engaging work environment with a focus on teamwork and collaboration
- Chance to make a positive impact on claims accuracy and provider management
- Involvement in critical oversight and auditing processes
What to Expect (Job Responsibilities):
- Conduct comprehensive contract reviews and targeted claims audits to ensure accuracy and compliance
- Validate data in claims and provider databases, ensuring adherence to business and system requirements
- Maintain and manage the audit workbook, providing summaries of assigned tasks
- Track and follow up on findings with stakeholders and requestors
- Ensure timely completion of assigned tasks in accordance with department standards
What is Required (Qualifications):
- Associate's Degree or equivalent combination of education and experience
- Minimum of 2 years of comprehensive claims processing experience (QNXT) as an examiner or adjuster
- Knowledge of CMS rules and state regulations related to various lines of business, including Medicare and Medicaid
- Proficiency in claims audit tools such as QNXT, PEGA, and Claims Viewer
- Strong analytical, problem-solving, and customer service skills
How to Stand Out (Preferred Qualifications):
- Bachelor's Degree or equivalent combination of education and experience
- 3+ years of experience in claims audits or related roles
- Familiarity with payment methodologies such as Stoploss, DRG, and FFS
- Advanced proficiency in Microsoft applications including Excel, Word, and PowerPoint
#HealthcareServices #ClaimsAuditing #CareerOpportunity #CompetitiveBenefits #AnalyticalSkills
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