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Claims Quality Assurance Coordinator

Remote:

Full Remote

Contract:

Full time

Experience:

Entry-level / graduate

Work from:

United States

Offer summary

Qualifications:

HS Diploma or equivalent, 2 years' advanced claims processing.

Key responsabilities:

Conduct pre and post-payment audits
Evaluate data for quality assessment
Identify trends for improvement
Support external claim audits
Complete assigned quality projects

MedCost LLC Insurance SME https://www.medcost.com/

201 - 500 Employees

See more MedCost LLC offers

Job description

Position Summary:

Under the direction of the Director or Finance, this role is part of a team responsible for the daily administration and development of the Quality Assurance program. This includes auditing of a variety of claims transactions. They will audit to ensure delivery of “best in class service” to our customers and aid in identifying recommendations for areas of quality improvement by diagnosing trends and training needs.

Position Responsibilities:

Conduct the pre-payment audit process including, but not limited to over dollar limit claims, flagged auto-adjudicated claims for audit, and new group initial check runs audits, according to MBS processing guidelines.
Conduct the post-payment audits including targeted audits and random audits.
Support management of and assess quality, by evaluating data from various sources including, but not limited to, undeliverable mail, incoming correspondence, returned checks and incoming inquiries.
Provide feedback on areas for quality improvement by evaluating all source material owned by the Quality Team.
Ensure all claims on audit hold are released for end of contract.
Identify and recommend continuing education topics and trending errors.
Support external claim audits as established quality owner on specific tasks identified. Participate in external audits including presenting audit scenarios to external auditors and discussing the outcome of the claim.
Responsible for completion of quality assigned projects.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

Required

HS Diploma or equivalent
2 years’ experience of advanced claims processing in PowerStepp
Previous experience in administration of self-funded group health plans

Skills

Skills, Knowledge and Abilities

Proficiency in using Microsoft Office and Powerstepp claims platform.
Knowledge of quality assurance terminology, methods, and tools
Analytical, problem-solving, and decision-making skills
Strong critical thinking skills.
Strong understanding of MedCost Benefit Services claims policies and procedures
Ability to identify trending of errors and educational/training opportunities for analsyts
Strong written and verbal communication skills
Ability to shift priorities as needed to multi-task.
Ability to work across departmental lines to meet company goals.
Effective problem-solving skills.
Excellent time management and organizational skills
Ability to work independently and collaboratively in a team environment.
Ability to exercise discretion when dealing with confidential personal health information and other sensitive information.

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.