Medical Claims Reviewer

2 weeks ago

Randolph Air Force Base, TX, United States OSI Vision Full time

We are seeking Medical Claims Reviewers to assist the Air Force Security Assistance and Training (AFSAT) Squadron in monitoring the welfare of U.S. Air Force-sponsored international students.  Selected individuals will perform medical claims review activities, receive and process treatment requests, and provide guidance to treatment facilities.

Primary Responsibilities

  • Perform medical claim review activities in support of Security Assistance and Security Cooperation training programs.
  • Receive, track, and verify medical, dental, and pharmacy pre-authorizations and claims for International Military Students (IMS) and their dependents.
  • Verify that the International Classification of Diseases (ICD) codes on the claims comply with treatment diagnosis using most recent ICD guidance, advocate for reduced treatment costs and provide claims to AFSAT/FMF for processing.
  • Provide validation/return of treatment requests to facilities and resolve discrepancies.
  • Provide guidance to treatment facilities, military base referral service (may be the TRICARE Office) on IMS medical insurance process, explain student Invitational Travel Order (ITO) and various ways student medical bills may be reimbursed.  

Knowledge and Experience Requirements

  • 2 years of related medical claims work experience with at least (1) year working for the DoD (preferably the Air Force) in a medical claims position.
  • Working knowledge of medical terminology, insurance terminology, agencies policies, practices and regulations, various health care delivery and information systems to accomplish pricing analysis, third party collections, (ICD) codes, procedure codes and evaluation and measurement codes.
  • Working knowledge with the latest version of Microsoft Windows (e.g., 10), and Microsoft Office applications (e.g. Excel, Word, PowerPoint, Access).
  • Ability to become familiar with the Defense Security Assistance Management System (DSAMS) and proficient with the Security Assistance Network Web (SANWeb) within 90 days after employment.
  • Clearance Level: Tier 1 background investigation (formerly known as a NACI) required prior to issuance of a Common Access Card (CAC).

Language Skills

  • Ability to read, analyze, and interpret technical procedures and governmental regulations
  • Ability to write reports.
  • Ability to effectively present information and respond to questions from managers, clients and customers

Reasoning Ability

  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

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