Claims Audit and Recovery Specialist (Medical)

Position Summary

Reasons you will want this position:

• Our culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyone
• Remote hybrid work schedule with flexible hours in Houston, Texas.
• This is viewed as a key position for our continued success, and it will have a direct impact on client satisfaction.
• We are a rapidly growing company with limitless career growth and advancement for top performers

Summary
As the Claims Audit and Recovery Specialist, you will audit claims for both inbound and outbound claims activity. In addition, the claims audit and recovery specialist will recover overpaid claims, manage recovery activity, and manage leakage activity. You will be communicating regularly with Cedar Gate leadership and clients.

Roles & Responsibilities

• Conduct claim audits of external inbound claims activity for various clients to ensure that the claims processed have all appropriate charges required for packing.
• Conduct claim audits of claims processed by NDBH staff to assure adherence to processing policies and guidelines.
• Ensure accuracy standards are met.
• Prepare reports on audit results, identify trends, and implement quality improvement activities for improving business processes.
• Pursue and manage recovery of inappropriate overpayments and apply recoveries to the claims payment system.
• Track and report leakage details, including the review and audit of incoming leakage reports
• Assist in the preparation of settlement and recovery reports.
• Follows interdepartmental policies and procedures as set by supervisor/manager.
• Provide coverage for all essential functions of billing activities (data entry, claim filing, claim storage, claim auditing, and cross-training on package protocols per assignment).
• Maintain confidentiality of all information in accordance with HIPAA and with company information.
• Attend all regular staff meetings.
• Participate in continuing educational programs to maintain current on area of specialty.
• Work overtime, as required.
• Performs other tasks as assigned by supervisor/manager.

Job Location:

Hybrid Remote from our office in Houston, TX

Required Experience / Qualifications

• Certificate or associate degree in claims billings; Certified Coding Associate or Certified Professional Coder preferred
• Three (3) or more years of claims processing experience.
• Two (2) years of audit or recovery experience, preferably with medical claims.
• Ability to communicate with others clearly, tactfully, and professionally.
• Must be detail-oriented and proficient in data entry skills
• Advanced reporting in Microsoft Excel
• Currently eligible to work in the USA without a work visa, except for those with TN visas

Your Future Working Environment

If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

Based in Greenwich, CT, Cedar Gate is private equity backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit www.cedargate.com.