Management of QDA Part A Analysts and participation in query development process, including:
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
- 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.
- 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.
Las Vegas, NV (must be willing to relocate immediately)
SALARY & BENEFITS
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 firstname.lastname@example.org 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
HealthDataInsights Inc. - 2 years ago
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HealthDataInsights created world-class advisory boards with expertise in the management of quality, technology and human resources/employee...