1+ months

Healthcare Eligibility Analyst, Sr.

Sunrise, FL 33351
Regular Full Time
   

Responsibilities:
The Sr. Healthcare Eligibility Analyst reviews and analyzes large volumes of client records, investigates coverage to determine primacy, and initiates coverage updates.  Additionally, the senior role leverages subject matter expertise and experience to perform a variety of activities and projects such as supporting team development, handling client requests, analysis, and reporting, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs. Maximize revenue for our clients recovery programs.

Essential Duties
Leverage knowledge and expertise in COB/TPL/MSP to gather and review documentation and eligibility information, investigate the file to determine proper order of benefits when multiple forms of coverage are available, resolve primacy issues.
Demonstrate ability to solve complex data or record discrepancies and/or issues.
Communicate effectively with carriers to updated validated eligibility records and primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
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, and demonstrates ability to respond to complex questions.
Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
Actively collaborate with internal groups and/or functions with gathering and interpretation of the eligibility work to development for continuous improvement in workflow and systems. 
Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and/or providers.
Effectively works assigned inventories to  consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) demonstrating ability to consistently resolve the most complex eligibility discrepancies and questions.
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.
Supports management with inventory assessment and distribution to team members. 
Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation. 
Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business.
Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example.
Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management.  
Supports team training activities and contributes to development and enhancement of training materials and tools. 
Leads and contributes to ad-hoc projects and initiatives.
Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making.
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, quality, and completion of assigned projects with high quality and timely results.
Completes required processes to obtain client required clearances as well as company required 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.
Performs other duties as assigned.

 

*Notes:
All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.

Required Skills and Knowledge:
Strong knowledge and substantial experience with Healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovering and/or researching the same.
Experience with Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer
Proven strength gathering and interpreting Explanation of Benefits (EOB) to answer questions and resolve complex primacy issues.
Demonstrates high degree of critical thinking and analytical accuracy required to be successful in the role.
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 standard as well as complex issues with payments.
Protect 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; develops positive rapport with clients. 
Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
Intermediate to advanced Microsoft Excel skills.
Applies knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.) and can provide instructional support to others.  
Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members.
Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment; effectively serve as subject matter expert, lead by example, and a lead contributor to the team overall results and progress. 
Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change.
Ability to consistently perform job responsibilities.
Ability to obtain and maintain client required clearances as well as pass company required 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.

 

Physical Requirements:

**NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
Job is performed in an standard busy office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed). 
Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
Occasionally lift/carry/push/pull up to 10lbs.

 



Education and Experience:
High School diploma or GED; some college preferred: equivalent combination of education and related experience.
Minimum 4 years of directly related progressive experience (billing reclamation, recovery, eligibility, etc.), including Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer, demonstrating depth and breadth of knowledge and capability required for the position.
Minimum 1 year of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, contributing to the set-up of new clients or programs, or subject matter expertise applied to department workflows or projects, direct or indirect staff oversight or training, etc. 
Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or complex problem solving.



Other Requirements:

Must submit to and pass pre-hire background check, as well as additional checks throughout employment.
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment).
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.
  
Visa sponsorship is not available.

Job Profile is subject to change at any time.

EEO 
Performant Financial Corporation is an Equal Opportunity Employer. 
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER

 


   


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Posted: 2021-03-24 Expires: 2021-06-10

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Healthcare Eligibility Analyst, Sr.

Performant Financial
Sunrise, FL 33351

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