Healthcare Reclamation Analyst
$46,800–$46,800 year
RemoteUnited States
Job Summary
Review assigned client data and payer correspondence to investigate coverage, determine eligibility and primacy, and recover funds for clients who paid in error. Gather and interpret explanation of benefits and payer feedback to resolve discrepancies, answer carrier questions regarding Coordination of Benefits rules, and initiate documentation for successful payment or account action. Contact healthcare insurance carriers to clarify claim responses, educate them on complex rules, and contribute to continuous improvement of scripts and guidelines. Efficiently work through assigned inventories to meet productivity metrics while maintaining HIPAA compliance and adhering to company policies.
Required Qualifications
- Minimum 2 years of directly relevant progressive experience in billing reclamation or directly related role demonstrating application of similar depth of skills and knowledge and capability required for the position.
- Minimum 12 months relevant collections/receivable experience with consistent high production results.
- Experience demonstrating research and analytical skills relevant to the position.
- Demonstrated solid applied knowledge and experience with Healthcare, medical terminology, and medical coding, preferably in roles generating, auditing, recovery and/or researching the same.
- Demonstrated relevant depth of skills and experience with Coordination of Benefits, Third Party Liability, and Accounts Receivable.
- Good research and investigative skills with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and consistently resolve primacy issues.
- Ability to communicate professionally and effectively with providers, carriers and other audiences regarding eligibility and/or Coordination of Benefits (COB).
- Proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve issues with payments.
- Protected patients' privacy, understands and adheres to HIPAA standards and regulations.
- Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
- Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
- Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
- Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.).
- Ability to follow process, procedures, and regulations in the workplace.
- Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment.
- Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
- Ability to consistently perform job responsibilities.
- Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
- Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.
- Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
- Work overtime as may be required.
Desired Qualifications
- High School diploma or GED.
- Relevant college courses or certification a plus.
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