What are the responsibilities and job description for the Medical Claims Auditor / Advocate II position at inAssist Health Management Solutions?
HealthLock (inAssist) Medical Claims Auditor / Advocate II
HealthLock (inAssist) is a leading provider of Healthcare Management Solutions, utilizing our Medical Claims Auditors / Advocates, comprehensive analytics, and tailored technology solutions. Driven by our commitment to our clients, we take pride in delivering exceptional service.
The Medical Claims Auditor / Advocate II reviews complex healthcare claims to identify discrepancies, verify pricing, confirm prior authorizations and benefits in an effort to reduce members’ out of pocket healthcare costs. You’ll need to be comfortable navigating multiple computer systems to find critical information as well as maximize your knowledge of the healthcare system. Critical thinking and attention to detail is crucial for accurate and timely case resolution.
Job Role :
- Review patient medical bills, correspondence, and Explanation of Benefits (EOBs) for errors.
- Liaise with insurance carriers and providers to address identified issues (e.g., appeal incorrectly denied claims, rectify billing errors, negotiate with providers regarding inappropriate billing).
- Communicate with providers and carriers via phone and email, ensuring prompt and professional responses, and going above and beyond to address concerns, making medical bills and paperwork a worry-free experience.
- Identify problems and inconsistencies using management reports and critical thinking skills.
- Utilize expertise and take initiative to resolve claims / billing issues.
- Review EOBs and examine claims for appropriate coding of CPT and ICD-9 and -10 codes and modifiers against charges that are billed.
- Apply appropriate processes and procedures for medical claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates).
- Review and apply member benefit plans and provider contracts, pricing, CMS rate letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim.
Job Requirements :
Benefits you will enjoy when you join our team :
Join a rapidly growing and dynamic healthcare company!