Offer summary

Qualifications:

High school diploma or equivalent is required., 1-3 years of relevant work experience preferred., Strong attention to detail and accuracy in claim processing., Knowledge of healthcare terminology and contract language..

Key responsibilities:

Analyze and investigate incorrectly paid insurance claims.

Communicate with insurance companies via phone and written correspondence.

Research information from multiple sources to identify underpayments.

Manage multiple projects and ensure timely completion.

Job description

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY:

The Revenue Analyst role consists of thorough and extensive analyzation and investigative assessment of claims that have been identified as paid incorrectly. Through phone and written correspondence with insurance companies, the Revenue Analyst initiates pursuit of incorrectly paid medical insurance claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Essential Functions:

Coordinate with Revenue Analyst manager and project leads for available accounts to research and assess for potential payer underpayments to pursue.
Compile and research information from multiple sources (e.g., hospital systems, internal software, payer and government websites) to identify and eliminate false underpayments.
Apply contract language to calculate correct payment to the hospital using key reimbursement methodologies.
Clearly and concisely document actions taken for internal and team review.
Send provider appeals ensuring patient demographics and claim details are accurate via mail, fax & provider portals.
Verify claims with updated coding have been issued and received. If not, route claims to appropriate work queue.
Review pursued accounts for insurance payments (cruising).
Manage multiple projects while adhering to deadlines
Other duties as assigned

Education & Experience:

High school diploma or equivalent
1-3 years relevant work experience preferred.
Strong attention to detail ensuring claim coding and processing is accurate.
Demonstrated ability to conduct research via multiple channels (internet, client and payer systems, and internal resources).
Professional yet persistent phone etiquette with ability to ascertain relevant information.
Demonstrated critical thinking and decision-making skills.
Flexible and adaptable, and able to work across multiple systems and projects.
Ability to apply complicated calculations and formulas.
Understanding of Healthcare terminology (e.g., CPT, HCPCS, ICD-10, IPPS, OPPS)
Comprehension of contract language, government publications, medical records, and other formal documents.
Ability to write succinct and clear notes and formal appeal letters.
Analytical and demonstrated ability to problem solve independently.
Intermediate computer skills, including MS Office (Excel, Word)
Must be able to work autonomously as well as work within a team to identify solutions

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

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