HC & Insurance Ops Sr. Assoc
Dell Financial Services L.P. - Quincy, MA

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Job Responsibilities:
The candidate will be responsible for auditing medical claims on a pre-payment basis in accordance with documented Claim Processing Guidelines, Contractual Terms, Plan Payment and Benefit Policies.

They should be able to comprehend and apply provider contract language.

This person is responsible to document audit results in a FOXPRO database for tracking and feedback purposes.

The auditor is responsible to conduct a preliminary root cause analysis for errors found, identify systemic quality issues, and follow-up with internal departments as necessary.

Auditors are responsible to attain and are measured against predetermined Quality and Productivity standards within the department as well as deadlines for completion of all audits and administrative tasks.


Required Skills:
3 to 5 years experience with medical claim processing systems and/or procedures

Familiarity with medical coding including CPT, HCPCS, ICD9, and DRG coding

Understanding of electronic claim processes

Demonstrated Analytic Ability

Excellent written and oral communication skills

Excellent organization skills

Desired Skills:
Hospital (UB04), Physician (CMS1500) Medical Claim Audit, Processing, or Billing Experience

Familiarity with hospital contract language, methodologies and reimbursement policies

Knowledge of industry standard code review editing software

Prior Audit experience helpful

Minimum Educational Requirements:
High School Graduate

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