Claims Specialist III
Job Location
Department
13 October, 2021
Full Time
Day
316223
Claims Specialist III
This job posting is no longer active.
Job Description
Overview
Performs tasks with limited supervision and provides guidance to the staff by ensuring Indiana University Health Plans claims processes and documentation are compliant with internal guidance, industry standards, contractual commitments and plan obligations. Secures data integrity by evaluating outcomes based on defined accuracy standards and serves as a point of escalation for highly visible claims cases. Ensures outcomes of claims adjudication are consistent with organizational and governmental expectations. Supports the audit process of Claims Operations and IU Health Plans by maintaining, tracking and trending audit results, completing focused claims analysis and reporting upon request. Participates in the training of Entry and Intermediate Level Specialists. Supports management by identifying and communicating claims data quality trends and is accountable for facilitating opportunities to develop and implement process improvement. Researches new and updated state and federal rules and guidelines as applied to all product lines. Serves as a goodwill advocate for Customer Service by successful completion of claims data outcomes monitoring and resolution.
• 5-7 years of experience in claims coding, claims audit, compliance or equivalent combination of education and experience in a healthcare setting required.
• R.H.I.T, C.C.S, C.C.S-P. CPC-H preferred.
• Experience in CPT4, ICD-10, HCPCS, DRG and APC is required.
• Knowledge required of Federal and State laws and regulations including CMS and IDOI.
• Intermediate skill levels required in MS Office, Word, Excel PowerPoint, Visio etc.
We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
Qualifications for the Claims Specialist III Role
Overview
Performs tasks with limited supervision and provides guidance to the staff by ensuring Indiana University Health Plans claims processes and documentation are compliant with internal guidance, industry standards, contractual commitments and plan obligations. Secures data integrity by evaluating outcomes based on defined accuracy standards and serves as a point of escalation for highly visible claims cases. Ensures outcomes of claims adjudication are consistent with organizational and governmental expectations. Supports the audit process of Claims Operations and IU Health Plans by maintaining, tracking and trending audit results, completing focused claims analysis and reporting upon request. Participates in the training of Entry and Intermediate Level Specialists. Supports management by identifying and communicating claims data quality trends and is accountable for facilitating opportunities to develop and implement process improvement. Researches new and updated state and federal rules and guidelines as applied to all product lines. Serves as a goodwill advocate for Customer Service by successful completion of claims data outcomes monitoring and resolution.
- Bachelors degree preferred or equivalent experience required.
- 5-7 years of experience in claims coding, claims audit, compliance or equivalent combination of education and experience in a healthcare setting required.
- R.H.I.T, C.C.S, C.C.S-P. CPC-H preferred.
- Experience in CPT4, ICD-10, HCPCS, DRG and APC is required.
- Knowledge required of Federal and State laws and regulations including CMS and IDOI.
- Intermediate skill levels required in MS Office, Word, Excel PowerPoint, Visio etc.
Indiana University Health is Indiana’s most comprehensive health system, with 15 hospitals and nearly 40,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.
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