Medical Claims Reviewer

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...