Senior Healthcare Reclamation Analyst

Role Overview

• Leverage knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.
• Successfully solve complex data or record discrepancies and/or issues.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately respond to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems.
• Actively contribute to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers.
• Effectively work assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment and consistently resolve the most complex eligibility discrepancies and questions.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.
• Support management with inventory assessment and distribution to team members.
• Provide ongoing feedback to Management and Analytics Teams to further the enhancement of products and services, workflows, and documentation.
• Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business.
• Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and lead by example.
• Conduct quality reviews on work performed by team representatives and analysts on the team as requested by management.
• Support team training activities and contribute to development and enhancement of training materials and tools.
• Lead and contribute to ad-hoc projects and initiatives and establishing best practices.

Requirements

• High School diploma or GED; college preferred: equivalent combination of education and related experience.
• Minimum 4 years of directly related progressive experience (billing reclamation, recovery, eligibility, etc.), including Coordination of Benefits, Third Party Liability, and/or Reclamation, demonstrating depth and breadth of knowledge and capability required for the position.
• Minimum 1 year of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, contributing to the set-up of new clients or programs, or subject matter expertise applied to department workflows or projects, direct or indirect staff oversight or training, etc.
• Demonstrated experience gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving.

Benefits

• medical
• dental
• vision
• HSA/FSA options
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually