What are the responsibilities and job description for the Medical Claims Investigator position at MultiPlan dba Claritev?
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY
This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments.
DUTIES
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Achieve measured production, quality, and growth results.
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Utilize analytics and data mining and coordination of benefits techniques to client paid claims data.
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Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes.
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Lookup and review medical claims in payer system to determine methods of payment and validate savings identified.
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Promote a positive team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals.
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Utilize official coding guidelines and resources as required, including CMS directives and bulletins.
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Collaborate, coordinate, and communicate across disciplines and departments.
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Ensure compliance with HIPAA regulations and requirements.
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Demonstrate Company's Core Competencies and values held within.
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Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
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The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
COMPENSATION
The salary range for this position is $50-55K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Salary : $50,000 - $55,000