Healthcare Reclamation Analyst

Responsibilities

• Review assigned client data and payer correspondence to determine eligibility, primacy, and the proper order of benefits.
• Investigate coverage, resolve primacy issues, and recover funds for clients who paid in error.
• Review documentation, eligibility records, claims responses, and explanations of benefits (EOBs).
• Resolve data and record discrepancies and support successful payment or other appropriate account action.
• Communicate with healthcare insurance carriers and providers regarding claim responses, eligibility, coordination of benefits, and payment issues.
• Educate carriers on coordination of benefits rules and respond to complex questions.
• Support internal teams with claims billing process and denial-management research and interpretation.
• Follow and improve scripts, guidelines, and tools for professional conversations with carriers and providers.
• Work assigned inventories efficiently while meeting productivity, quality, and other performance metrics.
• Research scenarios such as eligibility issues and claims appeals to reach resolution and payment.
• Initiate appropriate actions and document carrier contacts, demographic updates, account notes, and status changes in company systems.
• Follow company, departmental, client, HIPAA, and applicable regulatory requirements.
• Complete required training and client clearances, and correct deficiencies identified through quality reviews.
• Work independently and collaboratively, adapt to changing assignments and processes, and work overtime when required.

Requirements

• At least 2 years of directly relevant progressive experience in billing reclamation or a related role.
• At least 12 months of relevant collections or accounts receivable experience with consistently high production results.
• Research and analytical skills relevant to healthcare reclamation.
• High school diploma or GED; relevant college coursework or certification is a plus.
• Applied knowledge of healthcare, medical terminology, and medical coding, preferably in billing, auditing, recovery, or research roles.
• Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP), and accounts receivable.
• Ability to gather and interpret EOBs, answer payment questions, and resolve primacy issues.
• Professional communication skills for working with providers, carriers, and other audiences.
• Knowledge of HIPAA standards and regulations.
• Proficiency with computers, standard office applications, online tools, telephone systems, and related equipment.
• Ability to follow processes, procedures, regulations, and training; maintain attention to detail; and perform consistently.
• Ability to work remotely using computer and phone systems, online resources, high-speed internet, and a HIPAA-compliant workspace.
• Ability to obtain and maintain required clearances and pass background or drug screening.

Compensation and Benefits

• Pay range: $22.50 per hour.
• Medical, dental, and vision coverage.
• FSA/HSA.
• Tuition reimbursement.
• 401(k) with company match.
• Health and wellness benefits and other perks.
• Flexible, trusting work environment.