McLaren Health
Special Investigative Unit Analyst, Indiana
McLaren Health, Indianapolis, Indiana, United States, 46201
Special Investigative Unit Analyst
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org. MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org. Position Summary
Responsible for compliance and investigative technology support for both the legal and compliance needs of the Plan. Ensures compliance with all requirements related to Special Investigation Units. This is a hybrid position with requirements to come onsite as scheduled, Indianapolis, IN. Equal Opportunity Employer of Minorities/Females/Disabled/Veterans Qualifications
Required:
Associate degree in business, health care or related field or high school diploma with two (2) years of related experience.
Certification as RHIT, RHIA, CFE or CPC acceptable. Three (3) years' experience in progressively more responsible positions using analytical skills with at least two (2) years' experience in compliance or related function. Two (2) years' coding experience (specifically experience with CPT, ICD, HCPCS codes and standard industry billing procedures for both CMS 1500 and UB04 claims). One (1) year experience creating, maintaining, and editing SQL queries. Preferred: Bachelor's degree in business, health care or related field. Two (2) years' experience and knowledge of HMO, or PPO (e.g. accounting/finance, reinsurance, regulatory compliance, claims processing, membership/eligibility, and actuarial precepts). Course work or work experience in statistics. Additional Information
Schedule: Full-time Daily Work Times: 8:30 am - 5:00 pm Hours Per Pay Period: 80 On Call: No Weekends: No
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org. MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org. Position Summary
Responsible for compliance and investigative technology support for both the legal and compliance needs of the Plan. Ensures compliance with all requirements related to Special Investigation Units. This is a hybrid position with requirements to come onsite as scheduled, Indianapolis, IN. Equal Opportunity Employer of Minorities/Females/Disabled/Veterans Qualifications
Required:
Associate degree in business, health care or related field or high school diploma with two (2) years of related experience.
Certification as RHIT, RHIA, CFE or CPC acceptable. Three (3) years' experience in progressively more responsible positions using analytical skills with at least two (2) years' experience in compliance or related function. Two (2) years' coding experience (specifically experience with CPT, ICD, HCPCS codes and standard industry billing procedures for both CMS 1500 and UB04 claims). One (1) year experience creating, maintaining, and editing SQL queries. Preferred: Bachelor's degree in business, health care or related field. Two (2) years' experience and knowledge of HMO, or PPO (e.g. accounting/finance, reinsurance, regulatory compliance, claims processing, membership/eligibility, and actuarial precepts). Course work or work experience in statistics. Additional Information
Schedule: Full-time Daily Work Times: 8:30 am - 5:00 pm Hours Per Pay Period: 80 On Call: No Weekends: No