Medicare Supplement Claims Examiner

Atlantic American Corporation•Brookhaven, GA

13h•Onsite

About The Position

The Medicare Supplement Claims Examiner is a multifaceted role that combines the accurate and efficient processing of Medicare Supplement claims while upholding payment integrity and preventing fraud, waste, and abuse. The Medicare Supplement Claims Examiner will review claims for signs of fraudulent activity or improper billing practices, taking appropriate action to investigate and resolve these issues in collaboration with our internal stakeholders. In addition to claims processing and fraud prevention, the Medicare Supplement Claims Examiner will play a crucial role in identifying opportunities for cost savings and efficiency improvements within the claims processing system. Emphasis will be placed on ensuring all claims are processed in strict adherence to CMS guidelines, while providing expert guidance and support to the Customer Service Representative team. Dedication to accuracy, attention to detail and commitment to ethical standards in healthcare billing is essential to success in this role.

Requirements

Experience: Minimum 2-4 years of experience in Medicare Supplement claims processing or related field.
Knowledge: Comprehensive understanding of Medicare Supplement plans, 837 EDI transactions, DME claims, and relevant regulations.
Education: Bachelor’s degree in healthcare administration, business or a related field or equivalent work experience.
Analytical Skills: Strong analytical and problem-solving skills to evaluate claims and identify discrepancies.
Attention to Detail: Exceptional attention to detail to ensure accuracy in claims processing and documentation.
Regulatory Knowledge: In-depth knowledge of correct coding and CMS claim adjudication guidelines.
Technical Proficiency: Proficiency in using Microsoft Office Suite, claims processing and documentation applications.
Communication: Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
Integrity: Strong commitment to ethical standards in healthcare billing and fraud prevention.
Time Management: Ability to handle multiple tasks efficiently, prioritize work, and manage time efficiently in a high-volume environment.
Adaptability: Flexibility to adapt to changing industry trends, company policies and policyholder needs.
Collaboration: Ability to work collaboratively with internal stakeholders for fraud prevention.