Executive-Claims Management-Medical Billing and Claims Processing
• Responsible to reprice the non-par claims as per the Fee schedule and payment methodology. • Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language. • Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information. • Provide input for new process development and continuous improvement. • Supplier will share daily production report with stateside manager for review and feedback. • Maestro Health will provide all applications and accesses required for claim repricing. • Access requests should be completed within first week of project start date in order to start production. • Requirement gathering & training session will require active participation from Maestro Health manager. Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier. Skills Required: • Graduate with good written and oral English language skills • Expertise in using Claim processing and validation application and worked in past on same profile/portfolio. • Basic level proficiency on Excel to query production data and prepare/generate reports. • Analytical mindset with strong problem solving skills. • US Healthcare insurance domain experience desirable • Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes. Apply tot his job