Medical Claims Reviewer Job at OSI VISION LLC, San Antonio, TX

cHBvZFBTK0N3VDdUdEpoR2lTcmtxaTUrbmc9PQ==
  • OSI VISION LLC
  • San Antonio, TX

Job Description

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.

Job Tags

Work experience placement,

Similar Jobs

Foundation Health Partners

Non-Certified Phlebotomist Job at Foundation Health Partners

 ...40 hours per week, 4x10 hour shifts Shift Differentials Available: $2.00/hr. Weekend- $2.50/hr. Evening - $6.00/hr. Night This is a non-certified and/or entry level Phlebotomist role. This position is responsible for the collection and receipt of biological specimens... 

Bolthouse Fresh Foods

Sanitation Worker - 3rd Shift - Open Application Job at Bolthouse Fresh Foods

 ...America. Bolthouse Fresh Foods has approximately 1,600 employees. WHAT YOULL BE RESPONSIBLE FOR IN THIS ROLE The sanitation worker is responsible for the removal of raw products and solid waste from food contact surfaces to properly clean and sanitize the production... 

Active Staffing Services

Driver Helper Job at Active Staffing Services

 ...Job Description Job Description We are seekinga Driver Helperto join our team! You will assista truck driver in loading, unloading, and securing cargo, primarily within the "Just-In-Time" (JIT) delivery model, which requires precise timing and efficiency to meet... 

BestMed | Urgent Care | Primary Care

On-Site Occ Med Paramedic Job at BestMed | Urgent Care | Primary Care

 ...Position Summary: The On Site Occ Med Paramedic is responsible for performing patient triage, standard tests, procedures and patient care...  .... Requires an uninhibited drivers license to accommodate travel to off-site meetings and workgroup sessions. Fast paced clinical... 

Healthcare Support

Travel Dialysis Technician - $1,210 per week (Hiring Immediately) Job at Healthcare Support

 ...Healthcare Support is seeking a travel Dialysis Technician for a travel job in Mebane, North Carolina. Job Description & Requirements ~ Specialty: Dialysis Technician ~ Discipline: Allied Health Professional ~ Start Date: 03/17/2025~ Duration: 13 weeks ~...