Michigan Medicare Compliance Claim Analyst

AAA The Auto Club Group is seeking a Michigan Medicare Compliance Claim Analyst who will utilize web-based applications to analyze and process claims. The role involves reviewing claims, determining exposure, and acting as a liaison between customers and providers to ensure proper billing and reimbursement processes. Responsibilities Refer callers to appropriate individuals for additional information as needed May represent company at trials, depositions and settlement hearings 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 appropriate claims Determine validity of CMS liens Act as a liaison between the customer, and providers in order 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, etc Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable Skills College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience Claim analysis, or similar function Medical bill review (cost containment) operating a personal computer Utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.) Knowledge of one or more of the following: Medical terminology and human anatomy Knowledge of one or more of the following: CPT, ICD-9 and 10 and revenue codes (MBRU) Knowledge of one or more of the following: Property and casualty claims process and procedures Knowledge of one or more of the following: FACTS, IPM and CPS' Ability to use automated processing systems Ability to effectively respond to questions/concerns Ability to communicate effectively with others in a work environment, with the Public and vendors Ability to independently perform detailed, complex medical bill or similar analysis Demonstrated skill in organization and planning Demonstrated skill in analyzing and problem solving Demonstrated skill in written communications to include record keeping and report preparation Demonstrated skill in decision making Demonstrated skill in negotiating Associate's degree in Business Administration, Insurance or a related field Professional Coder Certification (CPT) for MBRU function Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent CPCU coursework or designation Significant medical bill analysis experience Knowledge of Negligence Law Knowledge of No-Fault Law Knowledge of Essential Insurance Act Knowledge of Fair Trade Practices Act as they relate to claims Knowledge of Auto Insurance Policy contract and coverages Benefits Medical, dental and vision benefits 401k Match Paid parental leave and adoption assistance Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays Paid volunteer day annually Tuition assistance program, professional certification reimbursement program and other professional development opportunities AAA Membership Discounts, perks, rewards, and much more Company Overview AAA - The Auto Club Group (ACG) is the second largest AAA club in North America, serving more than 13+ million members across 14 U.S. It was founded in 1901, and is headquartered in Dearborn, MI, US, with a workforce of 5001-10000 employees. Its website is