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Claims Analysis and Recovery (CAR)
Programmer/Reviewer



Responsibilities:
  • Review claims data at the systems level to determine aberrant billing patterns.
  • Assist in developing algorithms and other techniques to identify provider claims that do not conform to existing Indiana Health Coverage Programs (IHCP) policy.
  • Select providers for recoupment of overpayments.
  • Prepare provider overpayment letters with thorough research, after approval of the CAR Supervisor and SUR Manager, which comply with current IHCP policy and are completed in the designated timeframe.
  • Prepare and present letters and reports to the CAR Supervisor and SUR Manager.
  • Utilize VB.net and SQL to design and maintain the CAR database, which includes development, creation, maintenance, and performance monitoring functions.

Requirements:

  • Bachelor’s degree in business, health information administration, management information systems, computer science, or a health-related field.

  • Intermediate understanding of database extraction tools, SQL, and T-SQL, including knowledge of Microsoft SQL Server, Microsoft Access, Visual Basic, and other such tools.

  • Four years of recent experience in billing analysis or utilization review required, preferably with Medicaid, other government health care programs, or private sector health care reimbursement systems.

  • Familiar with procedural and diagnostic coding systems and policy and data analysis.

  • Careful worker who pays close attention to detail.

To be considered for this position contact our Personnel Department at 317-347-4500, or e-mail careers@hce.org. Please submit a resume and salary history.