UM Retrospective Review, Associate, Retro Support
Status: Full-time, Exempt: No
This role is responsible for all lines of business inpatient claims queue work. Reviews incorrect claims for inpatient/outpatient services. May review DME and Case Management claims. Is responsible for the Retro Review process as it pertains to medical record requests and processing incoming charts. Responsible for DRG and Retrospective Review record requests to appropriate hospitals. Knows and interprets the MVP benefits program, policies and protocols. Is responsible for policy, procedure and goal development. Documents and reports work volume, as it pertains to the work of the Retrospective UM Department. Discusses complex claims with UM leaders and carries out prescribed actions. Organizes work in order to promptly report a priority status concerning claims and retro issues within the department. Brings issues outside of department norms to the attention of the UM leaders for reference to Claims/ Operations and Quality Improvement issues. Completes other related duties as assigned.
Two-year college degree or equivalent experience required
Previous medical/hospital/office experience or medical insurance claim review experience
Excellent verbal and written communication skills.
Excellent computer skills including experience in MS Word and Excel.
Orientation toward customer service.
Familiarity with ICD-10, CPT-4 coding and medical terminology.
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- Job Family Medical Management/Clinical
- Pay Type Hourly
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America