Are you looking for an opportunity to advance your career while working with an extraordinary team? At Merakey, we put heart and soul into everything we do. We are seeking a full-time remote
Compliance Claims Examiner to join our team.
Position Details
The Compliance Claims Examiner will be responsible for ensuring all claim processes and decisions comply with organizational policies, state and federal laws and regulatory standards. This position reviews submitted claims and determines if there are any identified overpayments and is responsible for reporting to appropriate oversight entities. Position duties include:
- Reviews completed overpayments spreadsheets from investigation teams by utilizing billing reports to confirm if there was an overpayment
- Develops self-report and Issues letter and spreadsheets to the appropriate internal departments.
- Follow up with Program Management to gather any information when refuting an overpayment
- Issues overpayment letter to external stakeholders and collaborates with Merakey Business Operations and Finance to process payments.
- Utilize Internal QCO processing procedures and tracking. This would include (but not limited to) documentation and distribution of monthly and quarterly trackers, internal communication process(es) with Operational/Divisional leadership, logging all claims to be retracted/paid back to external stakeholders, updating the QCO database
- Interact with external stakeholders as needed for any follow-up questions related to the overpayment or any other concerns brought forth.
- Correspond with external stakeholders to negotiate parameters of an overpayment and retractions.
- Facilitate presentations/ training to Operations and new internal team members on overpayment process and reasoning.
- Provide a high level of customers service to all payers, providers, consumers, and Merakey Operational/Divisional Leadership.
- Coordinates quarterly meetings with QCO and Finance to review overpayment claims.
- Support QCO intake process as needed.
The Ideal Candidate Will Have
- Experience in business operations or claims management.
- Experience in processing claims and retractions with Managed Health Organizations, Medicare, Medicaid and other insurance plans.
- Fluent in Excel and proven ability to learn new platforms and databases independently.
- Advanced analytical and problem-solving skills with the ability to extract meaningful data.
- Strong written and verbal communication skills.
- Strong ability to understand workflows within QCO and other relevant Merakey areas
- Strong interpersonal skills to effectively work with executive leadership and others within the QCO and Merakey Operations.
- Advanced organizational skills.
Benefits
Merakey offers generous benefits that promote well-being, financial security, and work-life balance, including:
- Comprehensive medical, dental, and vision coverage, plus access to healthcare advocacy support.
- Retirement plan -- both pre-tax and Roth (after-tax) options available for employee contributions.
- DailyPay -- access your pay when you need it!
- On the Goga well-being platform, featuring self-care tools and resources.
- Access Care.com for backup childcare, elder care, and household services.
- Confidential counseling, legal, and financial services through our Employee Assistance Program (EAP).
- Tuition reimbursement and educational partnerships.
- Employee discounts and savings programs on entertainment, travel, and lifestyle.
- Access to Pryor Online Learning for free online personal development classes.
- Learn more about our full benefits package - https://www.merakey.org/careers/benefits
About Merakey
Merakey is a non-profit provider of developmental, behavioral health, and education services. More than 8,000 employees provide support to nearly 40,000 individuals and families throughout 12 states across the country each year. Click here to watch a video about Merakey.
Merakey strictly follows a zero-tolerance policy for abuse.
Merakey is proud to be an Equal Opportunity Employer! We deeply value diversity and do not discriminate on the basis of race, religion, color, national origin, ethnic background, sex, gender, gender identity, sexual orientation, age, marital status, veteran status, genetic information, or disability status. Moreover, we are committed to creating teams that reflect the diversity of the communities we serve and encourage applicants from underrepresented backgrounds to apply. Merakey welcomes all Veterans to apply!
