Michigan Medicare Compliance Claim Analyst

AAA The Auto Club Group is seeking a Michigan Medicare Compliance Claim Analyst to join their team. The role involves analyzing claims, processing Medicare Advantage requests, and acting as a liaison between customers and providers to resolve billing issues.

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
• For all Medical related areas: 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
• CPT, ICD-9 and 10 and revenue codes (MBRU)
• Property and casualty claims process and procedures
• 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
• Negligence Law
• No-Fault Law
• Essential Insurance Act
• Fair Trade Practices Act as they relate to claims
• 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