Provider Services Analyst I

ROLE AND RESPONSIBILITIES

• Maintains quality service by following corporate customer service practices and protocols
• Analyze claims to determine the validity of recovery options
• Draft detailed & convincing correspondence to effectuate reimbursement
• Contacting insurance carriers, patients, attorneys, and employers to facilitate reimbursement
• Contract interpretation as it relates to reimbursement, timelines, and verbiage of payer responsibilities guidelines to be followed
• Use of payer portals and other technologies to advance time to revenue
• Be able to identify defined root causes and trends from client inventories to formulate recovery resolutions or next steps in best practices
• Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

QUALIFICATIONS

• Prior experience reviewing, processing, and recovering in patient or outpatient clinical/technical post[1]service denials preferred
• Multi-state Knowledge of payer requirements preferred but not required specifically in appeal guidelines and timeframes
• Knowledge of UB04s and Claim Adjustment Reason Codes (CARC) and Reason Adjustment Reason
• Codes (RARC) is preferred
• Ability to resolve claims by composing a compelling appeal letter; guiding resolution of non-routine claims; auditing claims with decision resulting in a high overturn rate.
• Prior experience navigating EMRs (Cerner, Epic, etc.) and patient financial systems
• Thought leader with critical eye for detail
• Strong ability to effectively multi-task
• Superior verbal, written, customer service, and analytical skills with resolution is preferable.
• A continuous drive to stay abreast of healthcare industry policies and regulations
• Understanding of medical terminology used in administrative and clinical documentation is preferable
• Familiarity with Microsoft Office products
• Possession of a High School Diploma with some college
• 2-5 years of experience within the healthcare market
• 2-5 years of experience in navigating EMR and Patient Financial related software support systems, EPIC and Cerner experience a plus
• Previous experience within an acute care or outpatient environment of revenue cycle

MENTAL AND PHYSICAL DEMANDS

• This position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

RELATED DUTIES AS ASSIGNED

• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information.
• Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.