Buck Consultants, LLC. Buck-Senior Medical Claim Auditor - Remote in Dallas, Texas
Title: Buck-Senior Medical Claim Auditor - Remote
Location: United States-TX-Dallas
Other Locations: United States-California-Los Angeles, United States-New York-New York, United States-Illinois-Chicago
Job Number: 16027499
Within Xerox, Buck Consultants brings the full spectrum of human resource, benefits, and healthcare consulting to our advisory, technology, and administration solutions. Here you’ll discover an innovative, high-energy environment that inspires top achievement. As a prestigious highly successful leader in providing employee benefit, actuarial, outsourcing and HR management consulting services, we have the strong resources, solid reputation and global reach to enrich your work life and enhance your career.
Senior Medical Claim Auditor
This position will report into the Audit & Reporting Service Division and will be responsible for conducting and supporting medical claim audits (Dental, Vision, Behavioral Health, pre/post-implementation, etc) to validate the accuracy and proper adjudication outlined in the Medical Plan’s specifications.
Senior Medical Auditor Responsibilities: (Include but are not limited to)
• Manage and perform audits of medical claims payment data to validate conformance with specified coverage policies and payment methodologies as assigned.
• Review and understand the client’s Summary Plan Descriptions and Administrative Services Agreement.
• Work with IT to define the Plan parameters for use in reviewing electronic claim data within the audit software system.
• Review IT Audit Reporting, select and prepare valid audit sample following the standard departmental process and guidance received from the client.
• Travel to the administrator to conduct the site claim audit (Travel up to 60% of the year, Monday through Friday).
• Work with Administrator to resolve exceptions, review supporting documentation and make final claim error determination.
• Ensure audit timeline is adhered to and deliver high quality service to clients
• Prepare or assist lead auditor in preparing audit reports which clearly articulate the audit methodology and audit findings. Audit reports must be supported by work papers.
• Provide recommendations to Administrator for corrective action as well as identify areas for further consideration for delivery to the client and claims administrator.
• Work collaboratively within the audit team as well as with internal and external customers.
• Participate in team meetings, conference calls, WebEx’s, etc remotely / locally with administrators and audit team as necessary.
• Assist with Claims Data Analysis and Quality Assurance as requested.
• Assist in supporting lead auditors and Director as requested.
Desired Background and Experience:
• College degree (experience may be considered in waiving the degree requirement)
• 4-6 years of experience in claim adjudication from a major insurance claims administrator or health plan environment
• Previous Audit/QA experience
Proficiencies of Skills
• Proficient in the use of Microsoft Office Software (i.e., Word, Excel, PowerPoint)
• Strong organizational skills and the ability to efficiently prioritize multiple tasks
• In-depth knowledge of ICD-9, CPT, HCPCS, revenue codes and medical terminology
• Knowledge of CMS rules and regulations
• Must demonstrate a high level and familiarity of claims administration, including experience with medical, dental, mental health, prescription and Medicare
• Proficient with healthcare claim adjudication standards and procedures, including application of benefit plan designs, administrative services agreements, coordination of benefits and subrogation provisions.
• Excellent oral and written skills required
• Self-directed individual who requires little supervision and can work effectively independently or in a team setting
• Team player with a strong work ethic
• Previous internal audit, third party external auditing and prior consulting environment experience a plus
• Position requires 30 to 50% travel throughout the United States
• Auditor will have the ability to work remotely from any geographical location within the United States
Xerox Business Services, LLC and its subsidiaries is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender/sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, the basis of genetic information or any other group protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodation(s) by calling 866-419-2226 or by sending an e-mail to email@example.com.
Job: Buck Consulting-NonActuarial
Virtual/work from home? Yes