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UM Retrospective Review, Associate, Retro Support

Headquarters Office, 625 State Street, Schenectady, New York, United States of America Req #301
Friday, October 25, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Status: Full-time, Exempt: No


Summary:

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.


POSITION QUALIFICATIONS


Minimum Education:

Two-year college degree or equivalent experience required  


Minimum Experience:

Previous medical/hospital/office experience or medical insurance claim review experience

Required Skills:

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. 


MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

Other details

  • Job Family Medical Management/Clinical
  • Pay Type Hourly
  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America