About the position

As a Healthcare Coordination of Benefits Analyst , you will review assigned pre-pay or post-pay records, investigate coverage, and determine primacy to maximize revenue for our client’s recovery programs.

Responsibilities

• Review eligibility and other documentation to verify current payer order of benefits.
• Leverage your knowledge and expertise in COB/TPL to review eligibility, investigate the policy coverage to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Ability to identify trends from payer data in order to isolate policy details to process appropriately per client and business needs.
• Contact Healthcare Insurance carriers, employers, and/or providers regarding eligibility discrepancies.
• Educate Healthcare Insurance carriers, employers, and/or providers on the Coordination of Benefits rules.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs)
• Support internal groups or functions with gathering and interpretation of the eligibility work to develop knowledge base and understanding of key concepts and terminology in healthcare eligibility.
• Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and/or providers
• Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management.
• Leverage your knowledge and expertise to research various scenarios that will bring successful resolution and payment (e.g., eligibility research and claims appeals)
• Initiate applicable action and documentation based upon insurance carriers selected
• Update 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, as well as account status updates as applicable
• Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
• Follows and complies with company, departmental and client program 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 achieves or exceeds established metrics and goals assigned, including but not limited to, production and quality.
• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
• 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.
• Work overtime as may be required and pre-approved by management.
• Performs other duties as assigned.

Requirements

• Knowledge and experience with Healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
• Experience with Medicaid, Coordination of Benefits and Third Party Liability.
• Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve primacy issues.
• Ability to communicate professionally and effectively with providers, carriers, beneficiaries 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 payment.
• Proven ability to research coverage on online payer portals.
• 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.
• High School diploma or GED.
• Minimum 2 years of directly relevant progressive experience in Healthcare with a focus including but not limited to claims, billing, membership, enrollment, eligibility, customer service and/or call center demonstrating depth of knowledge and capability required for the position.

Nice-to-haves

• Relevant college courses or certification a plus.
• 12 months direct experience in COB, TPL, Reclamation and/or Recovery is preferred.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.