Process overpayments (post provider refunds, adjustments, offsets) requests, prepare notification letters.
Conduct outbound calls to healthcare providers to request payment recovery in a professional, courteous, and respectful manner.
Clearly communicate payment requests, claim details, and supporting information to provider offices.
Collaborate with internal teams to resolve discrepancies or provider questions efficiently.
Review claims for missing or incomplete information, calculate payment, or validation of identified overpayments.
Work under direct supervision with ability to analyze claim issues from identification to resolution and handle basic problems independently while collaborating with senior team member on more complex issues.
Responsible for reviewing and managing outstanding accounts receivable with guidance by operation leader, contacting providers to collect payment, and identifying issues with unpaid accounts.
Understand client specific policies related to claim payments, provider manual and member benefits.
Maintain legal compliance by following company policies, client policies, procedures, guidelines, as well as state and federal regulations.
Recognize and report system issues.
Prepare basic internal and external reports by collecting, analyzing, and summarizing information.
Maintain productivity goals and standards set by the department.
Executes functions with focus on accuracy and quality.
Complete special projects as assigned.

Healthcare Collections Analyst

Key skills