High Claims Medical Bill Auditor

The Arkansas Department of Transformation and Shared Services Office of State Procurement (TSS OSP) is seeking to procure the services of a High Claims Medical Bill Auditor to serve Pulaski County and the City of Little Rock. The initial contract term is up to three months, with the option to renew for up to six additional one-year terms, not to exceed a total of seven years. The selected Contractor will be responsible for reviewing and auditing approximately 75 high-value medical claims over the initial term, with the goal of identifying and recovering any overpayments or inappropriate charges. The Contractor must have a minimum of 5 years of experience in medical billing and coding auditing, as well as 5 years of consulting experience with government-sponsored healthcare plans with at least 100,000 covered lives. The Contractor's compensation will be based on a percentage of the recovery fees, with no additional fees charged.

The procurement is open to all qualified bidders, and there are no set-aside designations or restrictions on the types of organizations that can respond. The solicitation documentation does not mention any incumbent vendors or current contractors. The budget for the contract is not explicitly stated, but the pricing structure utilizes a sliding scale percentage fee applied to the claim amounts, with the extended cost calculated based on the Contractor's provided percentage. Prospective Contractors must submit a Technical Proposal and complete various required forms by the March 27, 2024 due date.