Insurance Recovery Analyst

About the role

Insurance Recovery Analysts process medical claims for various types of insurance including commercial, governmental, and third-party liability such as workmans compensation, general liability, and motor vehicle liability. Their primary responsibility is to ensure that clients (hospitals) recover the maximum allowable medical fees in a timely and efficient manner.

Responsibilities

• Investigates, negotiates, bills, and follows up for payment regarding first and third-party claims involving any and all coverages, liability, and legal issues.
• Identifies viable payers, obtains IBs, UBs, HCFAs, correspondence, and medical records when necessary.
• Maintains the highest level of privacy in accordance with HIPAA requirements and laws.
• Works their inventory by route while maintaining an acceptable level of aged accounts receivable.
• Contacts patients, payers, hospitals, attorneys, employers, and any other parties involved to collect necessary information and ensure reimbursement for the hospital.
• Appeals claims when applicable.
• Mets monthly company, team, and individual goals, and all deadlines set by the Team Lead and Manager, Operations.
• Completes special projects, as requested.

Qualifications

• Minimum of four (4) years of directly related industry experience.
• Emdeon/ChangeHealthcare billing experience is a plus.
• Epic, Cerner, and/or Meditech experience is a plus.
• Experience working claims in multiple states is a plus.
• Strong technical knowledge in one or more areas of commercial insurance, government insurance, workmans compensation, motor vehicle liability, general liability and claims processing systems.
• Knowledge of medical and insurance terminology.
• Knowledge of coordination of benefits.
• Working knowledge of FACS (ClaimAssists host system) or comparable management software system.
• Ability to speak confidently over the phone.
• Basic knowledge of Microsoft Excel and Word.
• Ability to provide quality customer service to all parties.
• Ability to work in a fast-paced environment.
• Demonstrated knowledge of state laws and insurance statutes.
• Excellent interpersonal and verbal/written communications skills.
• Highly motivated, self-starter, organized and detail-oriented.
• Able to work well individually, as well as part of a team.
• Coachable: receptive to feedback, willing to learn, embraces continuous improvement, and responsive to change.
• Able to maintain a predictable and consistent full-time work schedule.

Education Requirements

• Bachelor's degree in business or related field.
• Insurance Institute Certificate(s) highly desirable.
• Five (5) years of directly related experience in lieu of degree.