Healthcare Reclamation Analyst

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

The Healthcare Reclamation Analyst reviews assigned client data and payer correspondence, investigates coverage to determine eligibility and primacy, and gathers and interprets explanation of benefits and payer feedback in order to recover funds for clients who have paid in error.

• Leverage solid knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.

• Successfully solves data or record discrepancies and/or issues.

• Leverage your knowledge and expertise in COB/TPL/MSP to review documentation and eligibility, investigate the file to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action.

• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.

• Contact Healthcare Insurance carriers regarding claim responses.

• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions.

• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).

• Support internal groups or functions with gathering and interpretation of the claims billing process and denial management.

• Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, and/or providers

• Efficiently and diligently work through assigned inventories to consistently meet productivity metrics assigned by management.

• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (i.e.. 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.

• 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 achieve or exceed 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.

• Performs other duties as assigned.

• Minimum 2 years of directly relevant progressive experience in billing reclamation or directly related role demonstrating application of similar depth of skills and knowledge and capability required for the position.

• Minimum 12 months relevant collections/receivable experience with consistent high production results.

• Experience demonstrating research and analytical skills relevant to the position.

• High School diploma or GED. Relevant college courses or certification a plus.

• Demonstrated solid applied knowledge and experience with Healthcare, medical terminology, and medical coding, preferably in roles generating, auditing, recovery and/or researching the same.
• Demonstrated relevant depth of skills and experience with Coordination of Benefits, Third Party Liability, and Accounts Receivable.
• Good research and investigative skills with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and consistently resolve primacy issues.
• Ability to communicate professionally and effectively with providers, carriers 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 payments.
• 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.