Healthcare Audit Recovery Analyst

Job not on LinkedIn

2 days ago

Apply Now

Receive Emails with Similar Jobs

BASF

WebsiteLinkedInAll Job Openings

Chemicals • Agriculture • Healthcare

BASF is a global chemical company that operates across multiple sectors, providing a wide range of products and solutions. The company is focused on innovation and sustainability, serving industries such as agriculture, automotive, construction, electronics, energy, and healthcare. With a commitment to research and development, BASF aims to create chemicals that enhance the quality of life and support sustainable practices worldwide.

10,000+ employees

Founded 1865

🌾 Agriculture

📋 Description

• Conducts Medicaid claim audit reviews and determines if claims are appropriately paid in accordance with benefits, contracts and edits, includes review of specific coding and billing guidelines • Documents findings within audit tracking system and maintains thorough and objective documentation of findings • Investigates, researches, and analyzes claims data, applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive or inaccurate billing activity • Creates narrative rationale to correspond with audit determinations • As needed, supports findings during the appeals process • Serves as a claims payment resource; provides claims payment expertise, and claims payment guidance to the team • Works collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse • Monitors, tracks and reports on all work conducted • Consults with our clients, physicians, other claims payment resources and contractors as necessary • Maintains current knowledge of changes in technology, practice and regulatory issues that may affect our clients • Participates in process improvement activities and encourages ownership of and group participation in improvement initiatives • As needed, assists with quality assurance functions, development of medical review guidelines and training • Identifies and recommends opportunities for cost savings and improving outcomes • Attends conference calls and meetings as requested • Performs other duties as assigned

🎯 Requirements

• High School Diploma is required • Bachelor’s degree, or an equivalent level of competence obtained through experience, education and/or training, may be required for some specific roles • Medical Coder certification is a plus • Experience with Commercial healthcare contracts and Reimbursement models (e.g. Medicare, Medicaid, & Commercial Insurance), is required • 3+ years healthcare claims processing with experience in Medicaid claims • 3+ years of experience in the health care industry, preferably in an auditing role • 3+ years working with health care claims demonstrating expertise in, ICD-9/ICD-10 coding, HCPS/CPT-4 coding, and MS-DRG including medical billing experience for an Insurance Company or hospital

🏖️ Benefits

• medical • dental • vision • HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually