What are the responsibilities and job description for the Medical Claims Reviewer position at OSI VISION LLC?
About the Role
Osi Vision LLC is seeking Medical Claims Reviewers to support the Air Force Security Assistance and Training (AFSAT) Squadron at Randolph AFB. In this role you will monitor the welfare of U.S. Air Force-sponsored international students by reviewing and adjudicating their medical, dental, and pharmacy claims — ensuring accurate coding, appropriate reimbursement, and compliance with U.S. Air Force insurance processes.
This is a detail-oriented, mission-critical position. You will be the primary point of contact between treatment facilities and AFSAT's financial management function (AFSAT/FMF), and you will be expected to identify and resolve discrepancies, explain insurance processes to providers, and advocate for cost reductions on behalf of the program.
Primary Responsibilities
- Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards.
- Receive, track, and verify pre-authorization requests; resolve discrepancies and communicate outcomes to treatment facilities.
- Verify that ICD codes on submitted claims comply with the treating provider's documented diagnosis, using current ICD guidance.
- Advocate for reduced treatment costs and prepare validated claims for submission to AFSAT/FMF for processing.
- Explain IMS medical insurance processes and Invitational Travel Order (ITO) coverage to treatment facilities and coordinate with the base TRICARE Office as needed.
- Become familiar with the Defense Security Assistance Management System (DSAMS) and proficient in Security Assistance Network Web (SANWeb) within 90 days of employment.
- Maintain accurate records and produce clear written reports on claims activity, discrepancies, and resolutions.
Knowledge & Experience Requirements
Required:
- 2 years of direct medical claims processing or adjudication experience.
- 1 year of medical claims experience in a DoD or U.S. Air Force setting (military treatment facility, TRICARE, or DoD contractor supporting medical claims).
- Working knowledge of ICD-10-CM, CPT procedure codes, and HCPCS codes and how they relate to medical necessity and accurate reimbursement.
- Familiarity with medical terminology, insurance terminology, payer policies, and healthcare delivery systems.
- Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, Access) and Windows 10 or later.
- Ability to read and interpret technical procedures, governmental regulations, and payer policy documents.
- Strong written and verbal communication skills; ability to explain complex insurance concepts clearly to non-specialists.
Preferred:
- Direct experience with CHCS, AHLTA, or MHS GENESIS military health information systems.
- Familiarity with TRICARE authorization requirements and coordination-of-benefits rules.
- Experience in a claims environment involving international patients or government-sponsored travel programs.
- Existing CPC, CCS, RHIT, or equivalent coding credential.