***Medical Claims Adjudication & Cost Recovery US MD *****

Job Description:Claims AnalystPOSITION SUMMARYTHE CLAIMS ANALYST IS RESPONSIBLE FOR CONDUCTING THE NECESSARY RESEARCH AND COORDINATION TO ENSURE THAT ALL CLAIMS INQUIRIES AND PENDED CLAIM ISSUES ARE HANDLED AND RESOLVED IN AN EFFICIENT AND EFFECTIVE MANNER.REQUIRED EDUCATION AND EXPERIENCE:BACHELOR DEGREE PREFERRED.MINIMUM OF 4 YEARS OF MEDICAL CLAIMS ADJUDICATION EXPERIENCE. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIESPROFICIENCY WITH ICD9 AND CPT CODING. CODING CERTIFICATION (CPC OR CCS) PREFERRED. FAMILIAR WITH CMS/MEDICARE CLAIMS RULES. STRONG COMPUTER SKILLS INCLUDING MS OFFICE AND SPECIFICALLY MS EXCEL.FAMILIARITY WITH THE FACETS MANAGED CARE SYSTEM IS A PLUS.************************************************Cost Recovery AnalystWork with Audit Manager and Medical Cost Recovery Analysts in a senior-level capacity, identifying areas for process improvements in Audit and Recovery Operation's drive for Operational Excellence. Is a team lead/trainer in the day to day performance of process activities related to Recovery and Audit Programs.REQUIRED EDUCATION AND EXPERIENCE5-7 years health plan and/or claim experience preferred. Certification of Medical coding or 5-7 years of extensive coding experience preferred. In-depth knowledge of managed care operations and products preferredBachelor's degree or 5 to 7 years of equivalent experience preferred. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIESIn-depth knowledge of managed care operations and products preferred. Extensive knowledge of COSMOS, Facets, or DIAMOND preferred. Extensive audit experience is preferred. Desk top applications such as Word, Excel, Access required. Ability to manage multiple priorities is an absolute must. Ability to analyze data to identify trends and issues. You can view all of our jobs online at http://www.ajilonconsulting.com



Job Experience:Position Requires:POSITION SUMMARYTHE CLAIMS ANALYST IS RESPONSIBLE FOR CONDUCTING THE NECESSARY RESEARCH AND COORDINATION TO ENSURE THAT ALL CLAIMS INQUIRIES AND PENDED CLAIM ISSUES ARE HANDLED AND RESOLVED IN AN EFFICIENT AND EFFECTIVE MANNER.REQUIRED EDUCATION AND EXPERIENCE:BACHELOR DEGREE PREFERRED.MINIMUM OF 4 YEARS OF MEDICAL CLAIMS ADJUDICATION EXPERIENCE. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIESPROFICIENCY WITH ICD9 AND CPT CODING. CODING CERTIFICATION (CPC OR CCS) PREFERRED. FAMILIAR WITH CMS/MEDICARE CLAIMS RULES. STRONG COMPUTER SKILLS INCLUDING MS OFFICE AND SPECIFICALLY MS EXCEL.FAMILIARITY WITH THE FACETS MANAGED CARE SYSTEM IS A PLUS.**************************************************Cost Recovery AnalystWork with Audit Manager and Medical Cost Recovery Analysts in a senior-level capacity, identifying areas for process improvements in Audit and Recovery Operation's drive for Operational Excellence. Is a team lead/trainer in the day to day performance of process activities related to Recovery and Audit Programs.REQUIRED EDUCATION AND EXPERIENCE5-7 years health plan and/or claim experience preferred. Certification of Medical coding or 5-7 years of extensive coding experience preferred. In-depth knowledge of managed care operations and products preferredBachelor's degree or 5 to 7 years of equivalent experience preferred. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIESIn-depth knowledge of managed care operations and products preferred. Extensive knowledge of COSMOS, Facets, or DIAMOND preferred. Extensive audit experience is preferred. Desk top applications such as Word, Excel, Access required. Ability to manage multiple priorities is an absolute must. Ability to analyze data to identify trends and issues. For immediate consideration, please submit your resume. Qualified candidates will be contacted for further discussion about this opportunity. We are unable to offer sponsorship or relocation for this opportunity. Preference will be given to local or commutable candidates. Thank you for your interest in Ajilon Consulting!