Provider Outreach Business Analyst II

Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. Candidates must reside within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.

Schedule

This position works an 8-hour shift from 8:00 am - 5:00 pm (ET) Monday to Friday. Additional hours may be necessary based on company needs.

Responsibilities

• Conduct outbound provider calls to confirm that services were rendered and that the provider was expecting payment.
• Review claim details to determine claim validity before initiating outreach, ensuring all required information is accurate and complete.
• Meet or exceed daily outbound call attempt requirements as established by departmental performance metrics.
• Maintain a QA (Quality Assurance) score of 95% or higher, demonstrating adherence to process, accuracy in documentation, and professionalism in communication.
• Meet all Service Level Agreement (SLA) requirements related to outreach, documentation, and productivity.
• Provide excellent customer service when interacting with providers, addressing questions politely and professionally.
• Follow Desk Level Procedures (DLPs), workflows, and operational guidelines to ensure consistency and compliance in all outreach activities.
• Accurately document call outcomes and follow-up activities in required systems.
• Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness.
• Analyze claim data to confirm recovery eligibility using applicable CPT, HCPCS, and ICD-10 codes.
• Utilize systems such as Facets and Macess to research claims, validate overpayments, and document findings.
• Collaborate with internal teams to clarify claim details and ensure accurate communication with partners.
• Prepare and maintain detailed documentation supporting recovery decisions.
• Provide recommendations for process improvement and assist with the implementation of corrective actions.
• Ensure compliance with all internal policies, regulatory requirements, and partner agreements.

Requirements

• Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

Skills

• 2–4 years of experience in healthcare claims analysis, payment integrity, or a related field preferred.
• Proficiency with Facets, Macess, and Microsoft Office (Excel, Word, Outlook) preferred.
• Experience with medical claims processing workflows and related systems preferred.
• Experience supporting payment integrity or claims recovery in a health insurance or managed care environment preferred.
• Prior experience identifying or developing new recovery opportunities/leads preferred.
• Familiarity with data analysis and/or query tools (e.g., SQL, Tableau, or similar) preferred.

Pay

For candidates working in Norfolk, Virginia, the salary range for this specific position is $61,000 to $92,000. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company.

Benefits

• Comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, and 401(k) with company match.
• Incentive and recognition programs.
• Equity stock purchase plan.
• Paid holidays and Paid Time Off (PTO).
• Wellness programs and financial education resources.