Engage in Outbound recovery calls, to Healthcare Carriers and Providers regarding improperly paid claims
Decision Support
Ability to accurately review supporting documentation provided to Performant, by Providers/Carriers to determine accuracy of finding or overpayment allegation, for Complex appeals and disputes.
Maintain current knowledge in Medicare and Medicaid practices and regulatory issues that may affect our clients.
Leverage your knowledge and expertise to research Overpayments and answer questions and/or provide information that will bring to successful resolution and payment.
Educate Healthcare providers/carriers on their obligation to pay.
Ability to analyze and understand written communication from insurance companies including explanation of benefits.
Support internal groups or functions with gathering and interpretation of the billing and collections work to development with knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
Leverages existing excel skills to create Provider centric reporting on demand, or at Managements request.
Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance providers
Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management
Ability to maintain and function in multiple client systems and environments at one time.
Updates 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, payment commitments, as well as account status updates as applicable.
Regularly sit/stand 8 or more hours per day.
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Requirements
Bachelor’s degree in relevant field or equivalent combination of education and experience
Significant experience along with a high school diploma, may also be considered in lieu of a completed degree
At least 3 years directly relevant professional working experience in a highly analytic or Recovery role
Experience in Healthcare Billing and/or Coding is required
Knowledge or experience with Healthcare, Coordination of benefits or Revenue cycle management, and the like.