Job description
Overview:
The
Provider Services Analyst provides account analysis for identifying and recovering client overpayments made to healthcare providers. Responsible for developing and managing Provider relationships, working independently to identify and secure Provider refunds. Explains audit policies and procedures to the provider; conducts exit conferences to review findings, and reschedules subsequent audits. Responsible for providing successful field performance within assigned territory.
Responsibilities:
- Provides on-site account analysis; analyzes the following situations to identify instances of health insurance overpayments and clarifies discrepancies: Payment received by more than one payor, Retroactive payments, Double billing/payments, Inaccurate postings, Change written off in excess of amounts actually billed, Debit contractual adjustments, Reclassification of accounts, Charges removed, Provider A/R collection systems modeling net revenue at the time of billing, Incorrect coordinator of benefits, Identification of refund trends that can be applied across contract base to maximize revenue.
- Provides summary reports to clients and internal staff on results of project work and their corresponding revenue implications.
- Invoices and communicates findings to our clients.
- Answers client questions on information provided and troubleshoots any issues.
- Ensures all processes meet HIPAA and Government security requirements with regards to sharing/storage of PHI (Personal Health Information).
- Establishes effective working relationship with both clients and internal staff.
- May assist with training new and current auditors.
- Meets or exceeds established production and revenue goals set forth by management.
- Ability to read EOB's
- Ability to function effectively under pressure and deadline oriented project demands as well as manage multiple initiatives.
- Ability to analyze information, use logic and processes to overcome obstacles and resolve problems.
- Ability to multi-task, establish priorities, and work independently to meet objectives.
- Ability to work proficiently with Microsoft Word, Excel, Power Point and Access.
- Ability to quickly gain a sound foundation of knowledge of the various major provider accounts receivable systems.
- Ability to work effectively in both team and individual environments.
- Ability to communicate both verbally and in writing, fluently in English.
- Ability to organize well.
- Ability to be versatile and easily adaptable to new regulations and rules from client to client.
- Working knowledge of HIPAA privacy and Security rules.
- Ability to diverse in different standards across the nation per client needs.
- Ability to be careful and thorough about detail.
- Ability to adhere to corporate policies and guidelines concerning audit protocol and adherence to HIPAA guidelines
- Ability to maintain and enhance existing customer relationships
- Ability to travel once COVID-19 restrictions are lifted
Minimum Education:
- High School Diploma or GED required, Bachelor’s or Associates degree preferred
Minimum Related Work Experience:
- Previous experience with EOB's and medical billing strongly preferred
- Previous healthcare billing experience, audit or collection and accounts receivable experience in a healthcare environment helpful, but not required
- Healthcare reimbursement or claim knowledge
- Demonstrated understanding of coordination of benefit rules
- Familiar with secondary billing, appeals, and contractual adjustments
- Understanding of healthcare claim billing and collection terminology
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