Medical Management Examiner - Hybrid

Auxiant•Cedar Rapids, IA

2d•Hybrid

About The Position

Serve as a liaison for Auxiant Medical Management (AMM) program. This position provides critical coordination and communication surrounding all moving parts of cost containment and medical management for our customer plans. The individual must be able to make sound decisions on partner recommendations based on the best interest of the client and participants and consistent with the plan document. The position will also work closely with the Medical Management Supervisor in a supportive roll. The individual will need to be efficient, accurate and excellent at multi-tasking. d exceptional organizational support. This position requires a reliable person who thrives in a fast-paced environment, manages competing priorities, and consistently delivers satisfactory work.

Requirements

High school diploma and 2-4 years related experience; or Associates or Bachelor’s degree with some related experience
General understanding of medical terminology & claims examiner experience
The ability to work independently.
The ability to load balance work.
Proficient PC skills including e-mail, record keeping, routine database activity, word processing, spreadsheet,10-key
Proven experience in a professional office environment
Outstanding written and verbal communication skills
Excellent mathematics and analytical skills

Responsibilities

Review High Dollar Claims and vendor recommendations and apply decisions based on the Plan Document, stop loss insurance, ppo contracts, etc.
Make clear and concise decisions in the best interest of client and the plan participant
Run reports for claim suspends and reconciliation for Accounts Payables
Coordinate with Claims surveillance partners
Claims processing, research and customer service
Data-entry
Manage all aspects of daily processes and accurately identify and present issues to vendors that will optimize the AMM program.