Medicare Compliance Claim Analyst - Michigan

Position Summary

The Auto Club Group is seeking a Michigan Medicare Compliance Claims Analyst to ensure accurate, compliant, and cost-effective medical claims processing. This role involves reviewing, analyzing, documenting, and managing medical claims, collaborating with various stakeholders, and resolving billing inquiries.

Key Responsibilities

• Review claim information to determine if ACG has an exposure of ORM.
• Process Medicare Advantage requests for reimbursement.
• Identify proper data if claim qualifies for reporting, if not remove from reporting.
• Report on appropriate claims.
• Determine validity of CMS liens.
• Act as a liaison between the customer and providers to research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization, and correct billing procedures to providers.
• Aid in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable.

Qualifications

• Required Education: College level coursework in Business Administration, Insurance, Management, or a related field.
• Experience: Claim analysis, medical bill review (cost containment), operating a personal computer, utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.).
• Knowledge and Skills: Knowledge of medical terminology and human anatomy, CPT, ICD-9 and 10 and revenue codes (MBRU), property and casualty claim process and procedures, FACTS, IPM, and CPS'. Ability to use automated processing systems, respond to questions/concerns, communicate effectively with others in a work environment, with the public and vendors, perform detailed, complex medical bill or similar analysis, demonstrate organizational and planning skills, analyze and problem solve, write communications to include record keeping and report preparation, make decisions, negotiate.
• Preferred Education: Associate's degree in Business Administration, Insurance or a related field.
• Experience: Processing or working within a medical claims environment, medical billing experience with both Medicare and Medicaid, exposure to processing or working with VA (Veteran Affairs) claims, working within a heavy team environment, performing both inbound and outbound calling to internal and external clients.

Compensation & Benefits Overview

• Salary Range: $23.72 - $29.17 per hour.
• Benefits: Medical plans with multiple coverage options, prescription drug coverage, dental and vision benefits, Employee Assistance Program (EAP), basic life insurance, optional supplemental life insurance and dependent coverage, short-term and long-term disability coverage, critical illness, accident, and pet insurance options, 401(k) plan, tuition assistance, professional certification support, career development and advancement opportunities, AAA membership with roadside assistance and travel discounts, adoption assistance program.