Hampton, VA, US
Aerotek is seeking a highly skilled Claims Analyst!
Process all Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.
Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
Calculate Other Health Insurance (OHI) COB amounts using the data from claim such as the EOB or prior payment information given. Identify when to pend to other departments based on guidelines.
Process all claim types by determining corrective action to be taken on various types of errors pended by the system and resolving interactive edits.
Translate, research, and verify claim information to determine if all requirements have been met.
Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals.
Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
Adjudicate specialty claims including, but not limited to, pharmacy, ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims or duplicate claims.
Characteristics and Responsibilities
- Receive telephone, written, fax, and e-mail inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing problems.
- Apply appropriate provisions of TRICARE regulations, interpretations, and procedural directives in making determinations on eligibility and benefits to determine appropriate responses to inquiries.
- Obtain and analyze claims data to determine specific problem area including external communication to obtain data.
- Complete research and provide final resolution to inquiries within contractual requirements.
- Communicate with inquirer to determine appropriate authorization or referral of services.
- Submit claims for adjudication, correction, payment, or review as appropriate.
- Educate providers on billing requirements of TRICARE to reduce claim problems.
- Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
- Respond to inquirer using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards.
- Collect and record data for Customer Service records and computer analysis.
- Inform supervisory staff of system problems when identified, researching problems to provide backup data and examples when needed.
Interested? Please apply below with a copy of your resume!
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email email@example.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.