Healthcare Billing Recovery Analyst

As a Healthcare Billing Recovery Analyst, you will be assigned a Provider portfolio and be tasked with managing it from a Recovery standpoint. In this role you will have the opportunity to leverage your well-versed background in Coordination of Benefits as well as Medicare/Medicaid and procedural challenges/regulations, and experience in generating outbound communications to Providers, with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues.

Key Responsibilities

• 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.

• 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.

• Arrives to work on-time, works assigned schedule, and maintains regular attendance

• Follows and complies with company and departmental policies, processes and procedures

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations

• Successfully completes, retains, applies and adheres to content in required training as assigned.

• Consistently achieve or exceed established metrics and goals assigned

• Demonstrates Performant core values in performance of job duties and all interactions

• Correct areas of deficiency and oversight received from quality reviews and/or management.

Knowledge, Skills and Abilities Needed

• Ability to demonstrate, strong written and verbal communication skills

• Basic understanding of revenue cycle management or Medical recovery.

• Strong knowledge and material experience with Healthcare, Medical terminology, Coding, Billing. Preferably a role in recovery or revenue cycle management.

• Demonstrates knowledge in post-payment recovery.

• Demonstrates the ability to solve complex Provider or Carrier billing questions, that assist in the resolution and understanding of the overpayment.

• Communicates effectively with Providers and Carriers to answer any questions and/or provide information that will bring successful payment or other resolution to the account.

• Demonstrated expertise in Medicare and Medicaid plans policy and procedure

• Up to date knowledge in Medicare/Medicaid appeal processing

• Knowledge in Coordination or benefits (COB)

• Demonstrates a high degree of critical thinking and analytical accuracy required to be successful.

• Proven ability to gather and interpret explanation of benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.

• Strong skills using standard office technology; Computer, various applications and navigation of on-line tools and resources.

• Intermediary to Advanced excel skills.

• Applies knowledge learned in training

• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.

• Must have the availability to communicate via phone with Providers and or Carriers in a quiet space 5+ hours daily.
   

Required and Preferred Qualifications

• 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.

• Other requirements may apply