Medical Claims Review Coordinator
Are you a nurse who enjoys applying your clinical experience to diverse claims analysis and bill reviews?
Would you like to have the opportunity to work from home?
If you are an RN with experience in medical bill review and experience in the clinical setting, we want to speak with you about a career at HMA.
If so…
We want to speak to you about a career at HMA.
HMA is a Third Party Administrator conveniently located in Bellevue with a dynamic, innovative Health Services department currently staffed by 15 RNs plus 9 other allied health personnel. We are a wholly owned subsidiary of Regence BS, and have been here for over 25 years. HMA serves over 100,000 employee lives on behalf our self-insured group health plans. We offer a generous benefit package, competitive salaries, profit sharing, a friendly, welcoming culture and the opportunity to work from home. Here is your chance to work with a vibrant, fun and knowledgeable team of RN’s with diverse clinical backgrounds.
The primary purpose of this position is the daily handling of medical necessity claim review, hospital bill review and stop loss renewal support, with responsibility for ongoing process improvement, to include policy and procedure improvement, in collaboration with other team members.
Essential Functions:
- Assisting in claims adjudication by reviewing claims referred for medical necessity determination.
- Perform hospital bill review for targeted claims based on established criteria.
- Negotiate discounts for non-PPO providers.
- Collaborate in the ongoing process improvement and maintenance of medical claims review program.
- Collaborate in the ongoing process improvement and maintenance of the Hospital Bill Review program.
- Provide information to specified departments on certain claims prior to client renewals.
- Identify health plan improvements prior to client renewals.
Successful Candidate will have:
- Current WA State RN License
- CMAS or CPC preferred
- 3-5 years clinical nursing experience
- 1 year payer-based utilization management experience
- 1 year medical claims review and/or bill review experience
- Computer proficiency including familiarity with MS Office products such as Word and Outlook required
Healthcare Management Administrators (HMA) believes in delivering superior value to our many self-funded Northwest clients by combining competitive rates with superior service. If you would like to learn more about our organization, please E-mail your resume, cover letter and salary history. Faxed resumes are welcome at 305/574-0443.
