Description
Medical Claims System Analyst:
Looking for a candidate who has an in depth knowledge of the full adjudication of Medical Health claims. This candidate must be able to help in providing knowledge and direction to IT/Claims Operations on standards and practices of being able to fully adjudicate a Medical Health Claim.
The candidate must possess the following skills and knowledge of such:
- Complete understanding of Adjudication of Medical Health Claims.
- Third Party Liability(TPL)/Coordination of Benefits(COB)
- Medical Code Sets
- Understanding of Vision, Transportation, & DME claims
- Understanding of NCCI editing
- Clear understanding of medical benefit structures.
- Excellent written skills and oral communication skills
- Excellent Analytical Skills and able to define business requirements.
- Minimum of 5 years experience
- In Depth knowledge of Medicare/Medicaid regulations.
- Understanding of Pricing and Authorizations
- Personality that is able to speak up and give direction