Medicare Compliance Analyst (Florida) at The Auto Club Group

It's a great time to join AAA The Auto Club Group!JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARDJob Type:Full timeExempt/Non Exempt:HourlyJob Description:Medicare Compliance Analyst (Florida) - The Auto Club GroupWhat 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 applicableSupervisory Responsibilities (briefly describe, if applicable, or indicate None):NoneWork 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 $25.00ACG offers excellent and comprehensive benefits packages, including:Medical, dental and vision benefits401k MatchPaid parental leave and adoption assistancePaid Time Off (PTO), company paid holidays, CEO days, and floating holidaysPaid volunteer day annuallyTuition assistance program, professional certification reimbursement program and other professional development opportunitiesAAA MembershipDiscounts, perks, rewards, and much moreWe'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 functionMedical bill review (cost containment) operating a personal computerUtilizing 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 anatomyCPT, ICD-9 and 10 and revenue codes (MBRU)Property and casualty claims process and proceduresFACTS, IPM and CPS'Ability to:Use automated processing systemsEffectively respond to questions/concernsCommunicate effectively with others in a work environment, with the Public and vendorsIndependently perform detailed, complex medical bill or similar analysisDemonstrated skill in:Organization and planningAnalyzing and problem solvingWritten communications to include record keeping and report preparationDecision makingNegotiatingPreferred Qualifications:Education:Associate's degree in Business Administration, Insurance or a related field.Professional Coder Certification (CPT) for MBRU functionCompletion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalentCPCU coursework or designationExperience:Significant medical bill analysis experienceKnowledge of:Negligence LawNo-Fault LawEssential Insurance ActFair Trade Practices Act as they relate to claimsAuto Insurance Policy contract and coverages#LI-LC1Who We AreBecome 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.comImportant 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.