Insurance Programmers IncLocation: Wallingford , CT 06492 Document ID: A7435-2FAD Posted on: 2013-11-0111/01/2013 Job Type: Regular
Minimum Education: Not Specified2013-12-01
Job Purpose: This position will perform monthly audits for specific Funds within Insurance Programmers, Inc. verifying Plan provisions have been applied in a consistent, accurate manner.
- Perform monthly medical, dental, vision and disability claim audits.
- Review claim samples for financial, statistical and payment accuracy and adherence to office performance standards. This includes, but is not limited to, review of contracted rates, eligibility verification, review of benefits allowed under specific plan benefits, turnaround time, in and out of network claims, physician, hospital, dental and disability claims. Audits will also include Medicare, Coordination of Benefits (COB) and third party liability claims.
- Document all audit findings.
- Audit and release high dollar claims.
- Identify error trends and provide quality reports to the Claims Manager.
- Secondary role includes working closely with operations Support Coordinator/Claims Manager.
- Performs other projects and duties as assigned.
- Results driven, detail driven problem solver
- Previous medical claim auditing experience
- Strong analytical and reporting skills
- Proficient in Microsoft Office Products (Word, Excel, Power Point and Access)
- Above average written and oral communication skills
- Dependable, reliable and conscientious
- Ability to work independently
- Exercises good judgment, effective decision-making, and ensures high quality.
- Knowledge of Health Insurance, products, services, CPT codes, ICD-9 codes, and medical terminology.
- Complies with HIPAA and all policies and procedures.
Experience: Previous medical claim auditing and claim processing experience required.
Education: College degree or a combination of education and work experience.
Insurance Programmers, Inc. PO Box 5817, Wallingford, CT 06492
Tel: (203) 269-7741 / (800) 446-8646
Fax: (203) 284-8656