Medicare Compliance Analyst (Florida)

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It’s a great time to join AAA The Auto Club Group!

JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD

Job Type:

Full time

Hourly

Job Description:

Medicare Compliance Analyst (Florida) – The Auto Club Group

What will you do:The Auto Club Group is seeking prospective Claim Analyst who will use Web Based and other applications to bill, document or analyze work.

In this position, you will have the opportunity to:

• Refer callers to appropriate individuals for additional information as needed.
• May represent company at trials, depositions and settlement hearings.
• Review claim information to determine if ACG has an exposure of ORM.
• Process Medicare Advantage requests for reimbursement.
• Identify proper data if claim qualifies for reporting, if not remove from reporting.
• Report appropriate claims.
• Determine validity of CMS liens.
• For all Medical related areas:
  • Act as a liaison between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to providers, etc.
• Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable

Supervisory Responsibilities (briefly describe, if applicable, or indicate None):

• None

Work EnvironmentThis is a hybrid work arrangement (time spent in office and remote). Depending on the employee’s role and leadership’s assessment, some employees will come into an ACG facility on a weekly basis, a monthly basis, or on an “as needed” basis for key meetings and collaborative activities. Most employees will be required to come into the office, to a minimum, for important departmental meetings or team-building events.

For this opening, employees will perform daily work duties on a remote basis with any needed in office visits outlined by management. This position will be required to report in office as outlined by the management team at minimum for team meetings and specific assignments.

Candidates must reside within 50 miles of Tampa, FL for hybrid purposes.

This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

With our powerful brand and the mentoring, we offer, you will find your position as aClaim Analyst can lead to a rewarding career at our growing organization.

How will you benefit:

• A competitive hourly salary between $21.35 to $25.00
• ACG offers excellent and comprehensive benefits packages, including:
• Medical, dental and vision benefits
• 401k Match
• Paid parental leave and adoption assistance
• Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
• Paid volunteer day annually
• Tuition assistance program, professional certification reimbursement program and other professional development opportunities
• AAA Membership
• Discounts, perks, rewards, and much more

We’re looking for candidates who:Required Qualifications (these are the minimum requirements to qualify):education (include minimum education and any licensing/certifications):

• College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience.

Experience:

• Claim analysis, or similar function
• Medical bill review (cost containment) operating a personal computer
• Utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.)

Knowledge and Skills:Knowledge of one or more of the following:

• Medical terminology and human anatomy
• CPT, ICD-9 and 10 and revenue codes (MBRU)
• Property and casualty claims process and procedures
• FACTS, IPM and CPS’

Ability to:

• Use automated processing systems
• Effectively respond to questions/concerns
• Communicate effectively with others in a work environment, with the Public and vendors
• Independently perform detailed, complex medical bill or similar analysis

Demonstrated skill in:

• Organization and planning
• Analyzing and problem solving
• Written communications to include record keeping and report preparation
• Decision making
• Negotiating

Preferred Qualifications:Education:

• Associate’s degree in Business Administration, Insurance or a related field.
• Professional Coder Certification (CPT) for MBRU function
• Completion of the Insurance Institute of America’s: General Insurance Program, Associate in Claims, Associate in Management or equivalent
• CPCU coursework or designation

Experience:

• Significant medical bill analysis experience

Knowledge of:

• Negligence Law
• No-Fault Law
• Essential Insurance Act
• Fair Trade Practices Act as they relate to claims
• Auto Insurance Policy contract and coverages

#LI-LC1

Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com

Important Note:

ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.

The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for the function of this job.

AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.

As an equal opportunity employer, ACG is committed to providing equal opportunity in all employment practices,
including but not limited to: selection, hiring, assignment, re-assignment, promotion, transfer, compensation,
evaluation, benefits, training and development, discipline and termination. The company prohibits discrimination,
harassment, and retaliation in employment based on race, color, religion, national origin, gender, sexual
preference/orientation, marital status, pregnancy, childbirth or related medical conditions, age, disability or
handicap, citizenship status, service member status, genetic information, or any other category protected by
federal, state, or local law. Violation of this policy may result in disciplinary action including termination of
employment.

 

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