Reimbursement Analyst/Claims Auditing

Kelly Services has an outstanding Temp-to-Hire opportunity with a national company in Chicago, IL - Downtown area.

 

Text Box: Job Description

 

Job Title:  Reimbursement Analyst Claim Check / Claims Auditing

Reports to: Manager, Professional Reimbursement Programs

# of positions: 3 Contract to Hire

Department:  Professional Reimbursement Programs

 

 

Job Purpose: 

This position is responsible for programing and implementing Enterprise claims auditing logic under the direction of the Manager Professional Reimbursement Programs.  Assists in the implementation, updates and maintenance of code auditing software. 

 

Job Responsibilities: 

  • Tests on-going edit changes for HCSC and Pearl Plans (4,000,000+ edits); includes development of Blue Chip/ITG Test Plan.
  • Researches internal code auditing inquiries from a variety of areas including FSUs, MRUs, PTC, HCSC and Plan Network Management/Staff.
  • Researches external code auditing inquiries from Providers
  • Documents HCSC and Plan decisions and customization to support internal audit review and internal/external inquiries.
  • Participates in the development and cross-divisional implementation of new code auditing logic for HCSC and Plans.
  • Prepares code auditing informational materials for internal areas (FSUs, MRUs, PTC, and PASS)

 

Required Job Qualifications:

  • Associate degree.
  • 2 years experience in the health care industry.
  • HIM certification, RHIT, RHIA, CCS, CCS-P, CPC, CPC-P.
  • Experience working with professional coding structures and claims auditing logic. 
  • Knowledge of medical practice patterns, professional coding and payment structures.
  • Clear and concise interpersonal, verbal and written communication skills.
  • Analytical and quantitative skills.

 

Preferred Job Qualifications:

  • Bachelor degree.

 

 

 

 

Why Kelly®?

Why Kelly®?

At Kelly Services®, we work with the best. Our clients include 95 of the Fortune 100™ companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.

About Kelly Services®

As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit kellyservices.com and connect with us on Facebook, LinkedIn and Twitter.

Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law.

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