Healthcare Billing Recovery Case Specialist I (SCA)

About the role

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence.

Responsibilities

• Leverage your knowledge and expertise in TPL/COB/MSP to review case documentation and any previous case work and activities completed by caseworkers to validate liability, responses to defenses regarding payment liability, status the account and letter correspondence, etc. in preparation to respond to and/or reach out to stakeholders.
• Answer questions (on the phone and/or in writing as appropriate) and/or provide information and education to the stakeholder(s) that will bring to successful payment or other appropriate account action.
• Initiate correct action with applicable party and documentation based upon payment option, actions required if review of case and/or new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
• Updates client and/or company systems with clear and accurate information such as involved party(ies) contacting the CRC, notes from contact dialog, as well as account status updates as applicable.
• Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
• Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
• 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.
• Successfully completes, retains, applies and adheres to content in required training as assigned.
• 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.
• 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.
• Works overtime as may be required.
• May be required to work some Performant holidays due to client requirement.
• Performs other duties as assigned.

Requirements

• Knowledge and experience with medical claim billing procedures, medical terminology and medical coding (including information in forms UB04 and CMS 1500), preferably in a role generating, auditing, recovery and/or researching the same including Medicare and Medicaid claims.
• Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP) with proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.
• Demonstrated ability to successfully complete high-quality MSP GHP and NGHP casework in accordance with company, client (CMS) and regulatory requirements.
• Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude and approach.
• 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.
• Possess a personality type that is ethical, friendly, hard-working and proactive.

Qualifications

• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate workspace for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.

Skills

• Knowledge of medical claim billing procedures, medical terminology and medical coding (including information in forms UB04 and CMS 1500).
• Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP).
• Interpretation and resolution of Explanation of Benefits (EOB).
• Effective communication and interpersonal skills.
• Attention to detail and self-motivation.
• Proficiency in standard office technology.

Benefits

• FTO, Paid Holidays, and Volunteer Days
• Tuition Reimbursement
• Company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options.

Pay

Pay range: $19.00 - $20.00 (hourly) USD
This is a non-exempt position. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

Schedule

Not specified