CTG MEDICAL CLAIMS AUDITOR I in Irving, Texas
Title: MEDICAL CLAIMS AUDITOR I
Job Number: 18212195
Computer Task group is seeking a Medical Claims Auditor for their client in Irving, Texas for a seven month contract.
We are seeking a talented individual for a Medical Claims Auditor I who performs research analytics to support our recovery audit line of business. Assists in the development and implementation of new data mining and audit/review methodologies for identifying healthcare over payments and underpayments to providers, and the detection of healthcare fraud, waste, and abuse.
Required Function 2:
Essential Responsibilities Participates in the review of health insurance claims and member eligibility information to uncover claims over payment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements. Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new over payment recovery opportunities. Works with data miners, clinical staff, and stakeholders to identify new over payment issues for each client.Tracks, and follows-up on results and recoveries. Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team. Develops, maintains, and ensures adherence to multiple project schedules
Required Function 3:
Knowledge, Skills and Abilities: Strong Conceptual and analytical skills• Strong Project management skills, Ability to develop, organize, and maintain project plans and agendas, Ability to effectively interface with clients on the phone and in person, Working knowledge of Microsoft Suite of products (Excel, Word, Access), Sound understanding or medical terminology and anatomy. Good understanding of Medicaid required, Medicare and commercial experience a plus.• In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs.• In depth knowledge of UB04 and medical (1500) claim formats and requirements.
Required Function 4:
Minimum Education:High school diploma or GED required; Bachelor’s degree preferred
Required Function 5:
Minimum Related Work Experience:1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. preferred.Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred
Please apply below or at email@example.com
CTG (NASDAQ: CTG) provides industry-specific IT services and solutions that address the business needs and challenges of clients in high-growth industries in North America and Western Europe. CTG also provides strategic staffing services for major technology companies and large corporations. Backed by more than 50 years of experience and proprietary methodologies, CTG has a proven track record of reliably delivering high-value, industry-specific staffing services and solutions to its clients. CTG has operations in North America, Western Europe, and India.
CTG's greatest asset is its people, and as such, we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work in Healthcare company by Modern Healthcare (2013-2016) in North America, and a Best Workplace in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).
CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.
CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.
Job: Health Payer