Medicare Billing and Reimbursement Manager
HealthDataInsights Inc. - Las Vegas, NV

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Management of QDA Part A Analysts and participation in query development process, including:
  • Researching Medicare policies to identify new audit concepts.
  • Developing data extract specifications to select claims not paid in accordance with Medicare policy.
  • Auditing data extract output files to ensure all claims selected include the improper payment the audit concept is intended to identify.
  • Compile supporting documents, sample claims and audit approval request form for Medicare approval prior to implementing new audit concept.
  • Monitor proprietary system used for tracking audits and findings to ensure high degree of accuracy and maximum productivity.
  • Report audit outcomes to HDI Executive Management, Centers for Medicare and Medicaid Services (CMS) and CMS affiliated contractors.
  • Ensure departmental goals are consistently met or exceeded.
  • Perform all duties with vigorous attention to detail and focus on outstanding quality.---
  • Other duties as assigned

    • Five (5) to seven (7) years of management level insurance billing, claim processing and/or auditing experience, including:
      • In depth knowledge of UB-04 coding,
      • Claim reimbursement guidelines and methodologies, especially MS-DRG and APC,
      • Basic medical terminology and anatomy.
    • Ability to interpret complex reimbursement policies and identify new audit concepts.
    • Excellent analytical skills.
    • Direct Medicare experience highly desirable.
    • Advanced knowledge of Microsoft Office products, particularly MS Excel.
    • Outstanding organizational, work-flow and time management skills.
    • Ability to perform multiple tasks and prioritize simultaneously.
    • Aptitude for computer applications.
    • Excellent verbal and written communication skills.
    • Self-directed individual and team player.

    JOB Location

    Las Vegas, NV (must be willing to relocate immediately)


    Competitive salary plus medical, dental, vision, flex savings, pre-paid legal, short-term and long-term disability, and life insurance benefits in addition to a 401k retirement plan, nine paid holidays and a paid time off (PTO) plan.


    For immediate consideration, please submit your resume, salary & bonus history (mandatory in order to receive consideration for the position), and daytime contact information to marked “Medicare Billing and Reimbursement Manager" in the Subject heading of the e-mail. Please note that we will be unable to respond to each resume received, but also note that your resume will be reviewed in a confidential manner. Thank you for your time and interest! HDI is an Equal Opportunity Employer. PRINCIPALS ONLY

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    About this company
    HealthDataInsights created world-class advisory boards with expertise in the management of quality, technology and human resources/employee...