Medicare Auditor I

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Review and validate the integrity of Medicare files.

• Determine the primary coverage and coordinate necessary system updates.

• Assess End-Stage Renal Disease cases and establish Medicare primacy.

• Evaluate recovery opportunities identified by vendors and verify the validity of these recoveries.

• Address Medicare-related inquiries from Account Managers, brokers, groups, members, and other stakeholders.

• Assist with MSP inventory reporting, MRM hierarchy error review, and Claimstop/PLOG analysis.

• Utilize Medicare data, group size, and employment status to ascertain whether Horizon or Medicare is the primary payer.

• Process claims to reimburse Medicare or the Treasury Department in compliance with CMS Regulations.

• Update the tracking system as necessary.

• Research and apply benefits as required.

• Familiarize with and understand the New Membership System (NMS) and Nasco.

• Execute other related tasks as directed by management.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 2 years of experience in processing and adjusting claims.

• Familiarity with Medicare.

• Understanding of Medicare Secondary Payer regulations.

• Knowledge of NMS and Nasco.

• Acquaintance with internal sales systems NAEGS and CPL.

• Proficient computer skills.

• Ability to multitask, strong interpersonal skills, critical thinking, organizational skills, and excellent written and verbal communication skills.

• Proficiency in Microsoft Excel.

• Proficiency in Microsoft Access.

• Proficiency in Microsoft Word.

• Experience with Nasco, NCompass, NMS, FileNet, and Cirrus systems.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.