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Medical Management Examiner - Cedar Rapids

Job Summary

https://www.auxiant.com/

Auxiant’s Mission Statement and Core Values

Mission: An Independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL Results.

Core Values: Independent Solutions. REAL Results
Respect
Empowerment
Agility
Leadership

Be part of a growing and prospering company as an Medical Management Examiner in our Cedar Rapids, IA office. Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing, progressive, and family-oriented company offering an excellent wage and benefit package.

Job Summary:

Serve as a liaison for Auxiant Medical Management (AMM) program. This position provides critical coordination and communication surrounding all moving parts of cost containment and medical management for our customer plans. The individual must be able to make sound decisions on partner recommendations based on the best interest of the client and participants and consistent with the plan document. The position will also work closely with the Medical Management Supervisor in a supportive roll. The individual will need to be efficient, accurate and excellent at multi-tasking.

Essential Functions:

· Review High Dollar Claims and vendor recommendations and apply decisions based on the Plan Document, stop loss insurance, ppo contracts, etc.

· Make clear and concise decisions in the best interest of client and the plan participant

· Run reports for claim suspends and reconciliation for Accounts Payables

· Coordinate with Claims surveillance partners

· Claims processing, research and customer service

· Data-entry

· Manage all aspects of daily processes and accurately identify and present issues to vendors that will optimize the AMM program.

Nonessential Functions:

· Other duties as assigned or appropriate

Education/Qualifications:

· High school diploma and 2-4 years related experience; or Associates or Bachelor’s degree with some related experience

· General understanding of medical terminology & claims examiner experience

· The ability to work independently.

· The ability to load balance work.

· Proficient PC skills including e-mail, record keeping, routine database activity, word processing, spreadsheet,10-key

• Proven experience in a professional office environment
• Outstanding written and verbal communication skills
• Excellent mathematics and analytical skills

*Full benefits including: Medical,Dental, Vision, Flexible Spending, Gym Membership Reimbursement, Life Insurance, LTD, STD, 401K, 3 weeks vacation, 9 paid holidays, casual dress code and more