Medical Claims & Plan Configuration Auditor
- - Operations
- Minneapolis, MN, USA
- Full Time
Bind is a health technology and services company founded in 2016 and headquartered in Minneapolis, MN with a San Francisco satellite. Bind is health insurance for the way we live now. Unlike traditional health insurance that charges you for services you may never need or want, Bind is on demand: pay for what you need, not what you don't, and adjust your coverage when those needs change. Health coverage that's flexible, clear, and intuitive.
We are creative, collaborative, and a little bit fiery. The Bind team is comprised of like-minded individuals passionate about healthcare, and our cause is the collective act of rewiring it. We embrace new ideas. We're more wheel than cog. More spark than smoke. And we are playful and venturesome in our daily mission to render real and refreshing solutions to health insurance that works better for us all.
Medical Claims Plan Configuration Auditor
Bind is actively seeking a highly skilled, motivated, and experienced Medical Claims & Plan Configuration Auditor to play a critical role in auditing the configuration of a new claim platform and the ongoing auditing the medical claims processed on the system. A Bind Claims and Configuration Auditor will partner with technology, operations and plan design to ensure the Bind claim platforms align with the benefit plan. Focus, enthusiasm, and a dedication to excellence are all personal characteristics highly valued in the Bind organization.
- Audit and testing of new business initiatives, benefits, and contract reimbursement configuration to ensure that the claims adjudication system is functioning according to business requirements.
- Develop best practices and standard operational procedures for quality assurance and the auditing of medical claims.
- Perform claims UAT on new and revised benefit and pricing configuration.
- Identify improvements in configuration auditing process to enhance quality and efficiency.
- Prepare and present monthly and quarterly audit reports to leadership.
- Review medical claims (Random, High Dollar, Focus) to measure standards and service levels are met and that claims are being processed according to the benefit Plan.
- Work with subject matter experts to resolve exceptions, review supporting documentation and make final claim error determination.
- A bachelor's degree in a related field preferred.
- A minimum of five (5) years' service as a medical claims auditor and/or claim examiner in the health care field, preferably in the payer space.
- A deep understanding of payer operations, claim processing, and experience deploying a software product in the healthcare payer space.
- Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations; ability to translate analysis of data into meaningful outputs.
- Excellent project management skills, with ability to manage multiple priorities with tight deadlines, and demonstrated strong problem-solving skills and attention to detail.
- Experience working as a liaison between business and technical teams.
- Ability to drive completion of projects and initiatives, follow through on execution of chosen strategies and demonstrate an ability to stay the course despite obstacles.
- Knowledge of ICD-10, CPT, HCPCS, revenue codes and medical terminology.
- Proficient in MS Visio, Word, Excel, and PowerPoint.
- Knowledge and experience in a healthcare environment with HIPAA, ERISA and ACA requirements.
- Attention to detail.
- Highly self-motivated.
- Flexible and able to adapt to changing priorities and deadlines.
- Excellent communication skills, both written and spoken.
Bind is committed to providing equal employment opportunities. All qualified applicants and employees will be considered for employment and advancement without regard to race, color, religion, national origin, sex, disability, age, marital status, sexual orientation, veteran status, genetic information, or any other status protected by applicable law.