Claims Recovery Analyst I - Payer

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🔥 1 minute ago

🇺🇸 United States – Remote

💵 $50k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2023-01

Healthcare • Healthcare Insurance • Fintech

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Acquire knowledge of clients’ claims adjudication systems, member and provider contracts, and claim payment policies and procedures • Assist clients in identifying, validating, and recovering claim overpayments • Validate claims for algorithm accuracy and confirm no refund has previously been posted • Review and resolve disputed overpayments from clients/providers • Participate in knowledge sharing to resolve claim issues and obtain clarifications • Identify overpayment opportunities and trends by researching CMS and Medicaid claims processing policies, client adjustments, claims systems, and provider/member contracts • Interpret and analyze medical, pharmacy claims, provider, and enrollment data to identify trends and opportunities • Assist Management with concept approval information for client approval • Complete step-by-step instructions for algorithms moved to production • Represent Trend and its clients professionally • Cooperate with team members to meet goals and complete tasks efficiently • Provide Management feedback on inventory levels, algorithm effectiveness/productivity, and new trends or ideas • Collaborate with Management to identify opportunities, improvements, and innovative solutions • Escalate situations that could adversely impact business relationships • Train and assist new analysts while maintaining quality and production results • Perform other duties as assigned

🎯 Requirements

• Experience in identification, analysis, and recovery of claim overpayments • Bachelor’s degree in accounting, business, healthcare, or a related field • Equivalent work experience in a similar position may be substituted for educational requirements • High School Diploma or Equivalent Required • Excellent computer skills and proficiency in Excel • Strong communication and interpersonal skills • Strong analytical and problem-solving skills • Effective organization and time management skills • Ability to learn, understand, and apply new technologies • Experience with medical claims processing preferred • Experience creating and maintaining complex queries preferred • May be required to complete background and drug screenings and disclose personal health information or personally identifiable information

🏖️ Benefits

• Competitive salaries • Health insurance • 401(k) plan with employer match • Paid parental leave • Collaborative and innovative work environment • Reasonable accommodations for individuals with disabilities

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