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CTG MEDICAL CLAIMS AUDITOR I in Irving, Texas

MEDICAL CLAIMS AUDITOR I

Irving, Texas, United States

New

Information Technology

1 day agoPost Date

21200266Requisition #

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CTG is seeking to fill aMedical Claims Auditor Iopening for our client inIrving, Texas.

Location: Irving, TX

Duration: 11 months

Due to Covid restrictions, this position is currently remote and candidates must have strong internet while working from home until the office is back open.

Description:

The Medical Claims Auditor I 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 overpayments and underpayments to providers, and the detection of healthcare fraud, waste, and abuse.

Essential Responsibilities:

• Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment 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 overpayment recovery opportunities

• Works with data miners, clinical staff, and stakeholders to identify new overpayment 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

Experience in the following is recommended:

• Experience with revenue cycle management

• Familiar with EOB/Check requirements for claims

• Minor experience in analysis is preferred

• Experience in the past in a call center is a plus

Basic Qualifications:

• 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

Minimum Education:

• High school diploma or GED required; Bachelor’s degree preferred

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

CTG does not accept unsolicited resumes from headhunters, recruitment agencies, or fee based recruitment services for this role.

To Apply:

To be considered, please apply directly to this requisition using the link provided. For additional information, please contactLaura Dominguez at 888-284-6551 ext. 2114. Kindly forward to any other interested parties—thank you!

CTG’s Benefits Plan allows you to select insurance coverage that best suits your lifestyle, and take part in our savings programs and educational plans. We offer Flexible Spending Accounts, a 401(k) Retirement Plan, and an Employee Stock Purchase plan. Our educational plan comprises access to more than 2,000 web-based technical, professional and business development courses.

CTG (NASDAQ: CTG) has developed a reputation for responsiveness and reliability - traits that our clients say set us apart - since our founding in 1966. As one team, we create and deliver information and technology solutions that make our clients more successful and cultivate a workplace that attracts and develops the best people. Our vision is to be an indispensable partner to our clients and the preferred career destination for information and technology experts. CTG has operations in North America, South America, Western Europe, and India and regularly posts news and other important information online at www.ctg.com.

Our culture is a direct result of the people who work at CTG, the values we hold, and the actions we take. In other words, our people are the culture. It's a living, breathing thing that is renewed every day through the ways we engage with each other, our clients, and our communities. Part of our mission is to cultivate a workplace that attracts and develops the best people, reflected by our recognition as a Great Place to Work-certified company across many of our global operations.

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 and Affirmative Action Employer. CTG will assure equal opportunity and consideration to all applicants and employees in recruitment, selection, placement, training, benefits, compensation, promotion, transfer, and release of individuals without regard to race, creed, religion, color, national origin, sex, sexual orientation, gender identity and gender expression, age, disability, marital or veteran status, citizenship status, or any other discriminatory factors as required by law. Our Affirmative Action program serves to promote occupational equality and diversity through good faith efforts. CTG is fully committed to promoting employment opportunities for members of protected classes.

Additional Information

  • Job Function: Administrative Assistant

  • Education Level: High School Diploma/GED (±11 years)

  • Work Remote: Yes

  • Travel: No

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