Claims Analyst II

Overview

Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai.

 

Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company’s commitment to hiring and supporting active-duty and veteran employees.

Responsibilities

 

 

CLAIMS ANALYST II

 

• Conducts moderately complex reviews of claims during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts
• Applies Medicare guidelines in addition to an extensive knowledge of medical terminology and experience in the analysis and processing of Medicare claims in making determinations as to the appropriateness of payment coverage
• Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare payment policies
• Utilizes extensive knowledge of medical terminology and experience in the analysis and processing of Medicare claims and Medicare claims payment systems
• Coordinates and compiles the written Investigative Summary Report to the BI Analyst upon completion of the claims review
• Completes assignments in a manner that meets or exceeds the quality assurance goal for accuracy
• Maintains chain of custody on all documents and follows all confidentiality and security guidelines
• Performs other duties as assigned by Management that contribute to task order area goals and objectives and comply with the Program Integrity Manual and Statement of Work guidelines and CMS directives and regulations

 

 

 

Qualifications

Requirements:

• Bachelor’s Degree or equivalent related experience
• 2 - 7 years of experience
• Knowledge of, and the ability to correctly identify, Medicare coverage guidelines
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
• Must have and maintain a valid driver’s license for the state of residence
• At least two (2) years of experience using medical terminology and experience in the analysis and processing of Medicare claims

 

 

Physical Requirements:

 

This position requires the ability to perform the below essential functions:

• Sitting for long periods
• Standing for long periods
• Ambulate throughout an office
• Ambulate between several buildings

 

About Empower AI

All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm’s overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.