Medical Coding Specialist responsible for coding medical data in clinical trials. Collaborating with teams to maintain data integrity and ensure regulatory compliance.
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Hybrid Executive – Claims Management, Medical Billing and Claims Processing
Posted 2 months ago
About the role
- Claims Analyst responsible for repricing non-par claims per Fee schedule and conducting reviews of medical claims for correct reimbursement calculations.
Responsibilities
- Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.
- Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.
- Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.
- Provide input for new process development and continuous improvement.
- Supplier will share daily production report with stateside manager for review and feedback.
- Maestro Health will provide all applications and accesses required for claim repricing.
- Access requests should be completed within first week of project start date in order to start production.
Requirements
- Graduate in stream preferred science stream 1 - 2 Years
- Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.
- Basic level proficiency on Excel to query production data and prepare/generate reports.
- Analytical mindset with strong problem solving skills.
- US Healthcare insurance domain experience desirable
- Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.
Benefits
- Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.
- Requirement gathering & training session will require active participation from Maestro Health manager.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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