Job: Claims Recovery Auditor

The Claims Recovery Auditor is responsible for the review, identification and validation of claim overpayments. Areas of review and audit include but are not limited to Duplicate Payments, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits and Claims Payment guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Perform analytical review, research and audit of claims payment data to identify claim overpayments.

Request, track and report claim overpayments.

Document and log refunds in the claims processing system and internal data tracking module.

Contribute to the overall success and attainment of team goals by assisting with special projects and working overtime when needed.

Exhibit professionalism and perform in a manner that supports the company's emphasis on customer service and operational excellence.

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Excellent verbal and written communication skills

Knowledge of medical terminology, ICD-9 and CPT-4 coding required.

Experience with Microsoft Office applications including Word, Excel and Access.

Ability to work independently with minimal supervision.

Knowledge and understanding of Medicaid and Medicare claim payment guidelines.

EDUCATION and/or EXPERIENCE

Hospital and Medical Claims Processing experience.

Knowledge of APC and DRG pricing

Prefer previous claims auditing/financial analysis experience