Job Summary
- Company
- Connolly
- Location
- Philadelphia, PA
- Industries
- Accounting and Auditing Services
- Job Type
- Full Time
- Employee
- Years of Experience
- 5+ to 7 Years
- Education Level
- Certification
- Career Level
- Experienced (Non-Manager)
- Job Reference Code
- 245
Medical Claims Investigator-HEALTHCARE, MCO/HMO/Medicaid
About the Job
Medical Claims Investigator - HEALTHCARE, MCO/HMO/Medicaid
IMMEDIATE OPENING IN OUR PHILADELPHIA/CONSHOHOCKEN OFFICE
Connolly is a healthcare industry leader specializing in financial auditing, consulting and payment error identification services to commercial and government insurers across the country. We are a growing and profitable international recovery audit firm that serves clients in healthcare, retail, and commercial industries.
Responsibilities will include but is not limited to:
Qualification Requirements:
Additional Experience/Qualities:
Success factors
Connolly's most important resource is experienced, committed, and creative employees. The open and inclusive team-oriented culture encourages contribution and enables employees to go beyond to fulfill his or her potential. Connolly is unique in its uncompromising commitment to provide the highest level of quality in auditing services. Connolly offers careers with plenty of challenge and opportunity, in a rewarding atmosphere. If you have a proven track record of accomplishment, commitment, and passion for success then Connolly is the right choice for you.
*CB* ~Y~
Personal characteristics that contribute to an individual's ability to excel on the job.
Connolly Consulting's Non-Negotiable Values
IMMEDIATE OPENING IN OUR PHILADELPHIA/CONSHOHOCKEN OFFICE
Connolly is a healthcare industry leader specializing in financial auditing, consulting and payment error identification services to commercial and government insurers across the country. We are a growing and profitable international recovery audit firm that serves clients in healthcare, retail, and commercial industries.
Responsibilities will include but is not limited to:
- Investigate medical claim data and/or medical records to identify payment errors.
- Creation & development of new payment error projects/reports
- Investigate medical claims on client claim systems, conducting medical incident & coding reviews.
- Analyze and validate audit findings according to both Medicaid State regulations & payer processing guidelines / provider contracts.
- Communication with management & client on audit findings, assist with error validation process
- Audit, mentor and support; suggest improvements and recommendations to meet the highest level of client satisfaction.
Qualification Requirements:
- 5+ years healthcare claims/reimbursement experience
- Bachelors Degree or equivalent certification
- Proficient with all healthcare coding (CPT4, HCPCS, DRG, ICD-9, & Revenue Codes)
- Proficient with healthcare claim adjudication standards & procedures
- Experience with Managed Care reimbursement
- Strong analytical & i nvestigative skills
- Proficient in Microsoft products, especially Access and Excel
- Ability to work independently & as part of a productive audit team
Additional Experience/Qualities:
- Previous Claims Resolution Specialist experience
- Knowledge of insurance payer contracts
- Certified Professional/Hospital Coder a plus
- Medical record review experience a plus
- Knowledge of State Medicaid reimbursement policies & procedures
- Previous auditing experience a plus
- Previous managed care contracting experience
Success factors
Connolly's most important resource is experienced, committed, and creative employees. The open and inclusive team-oriented culture encourages contribution and enables employees to go beyond to fulfill his or her potential. Connolly is unique in its uncompromising commitment to provide the highest level of quality in auditing services. Connolly offers careers with plenty of challenge and opportunity, in a rewarding atmosphere. If you have a proven track record of accomplishment, commitment, and passion for success then Connolly is the right choice for you.
*CB* ~Y~
Personal characteristics that contribute to an individual's ability to excel on the job.
Connolly Consulting's Non-Negotiable Values
- Integrity
- Self-Motivated
- Passionate
- Team Player
- Results Oriented
- Reliable
- Professional
- Boundaryless Behavior
