Position Responsibilities:

• Review all re payments made by PRIME within Athena
• Identify claims for which no additional payment received and posted by PRIME
• Pull all associated EOBs for each patient identified by PRIME
• Identify WC patients for which PRIME applied an inappropriate discount not on PRIME's patient/client listing
• Calculate expected reimbursement using appropriate state fee schedules
• Determine accuracy of reajudicated reimbursement amounts
• Analyze gaps and errors in expected reimbursement versus any repayment amounts
• Maintain records of each claim reviewed for legal use

Special Qualifications:

Required:

• Annual MVR may be required per policy and procedure; background reports may be ran as needed throughout the course of employment.
• Ability to work independently with minimal supervision.
• Requires skill in computer systems and applications.
• Must have outstanding organizational and oral/written communication skills.
• Must be able to prioritize work to meet deadlines despite frequent interruptions.
• Ability to work in a team environment.
• Must be able to prioritize tasks and use good professional judgment in assigned duties

 The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.