Medical Specialist Principal - Life Company Medical Supplement Health Claims (Hiring Immediately)
USAA
Colorado Springs, CO
23 days ago
$164,780 - $314,960
Job Description
Join USAA as a Principal Medical Specialist and play a vital role in overseeing Medicare Supplement Claims. You will provide expert advice on health policies, assess claims accuracy, and conduct research on healthcare trends, all while making a meaningful impact for the military community.
Key Responsibilities
Advise on morbidity and claims risk of health policies
Support investigations related to Medical Procedures and CPT coding
Review complicated medical histories and ensure claims payment accuracy
Conduct research on medical advancements and public health trends
Provide expert consultation on Medicare Supplement policies and claims
Required Qualifications
Bachelor's degree or 14 years of experience in health fraud
10 years of progressive health fraud experience
6 years as a Registered Nurse (RN), Nurse Practitioner (NP), or Medical Doctor (MD)
4 years in medical coding and/or Medicare billing practices
Ability to interpret electrocardiograms and stress test tracings
Preferred Qualifications
US military experience
4 years of Medicare Claims Expertise
Medical Coding Proficiency with experience in CPT coding, IC-9, ICD-10, HCPC
Regulatory Experience with Medicare state and federal regulations
Investigation Skills for complex healthcare fraud reviews
Benefits & Perks
Comprehensive medical, dental, and vision plans401(k) and pensionLife insurance and parental benefitsAdoption assistancePaid time off and holidays16 paid volunteer hoursWellness programs