Healthcare Eligibility Analyst Ii

Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

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Healthcare Eligibility Analyst II

Job Code: 2023-50-6A-014

Location: Sunrise, FL - Remote

Status: Regular Full Time

Pay Range: 41600.00-62400.00

Responsibilities

The Healthcare Eligibility Analyst II plays an important role in the success of the Eligibility services we provide our clients by applying strong knowledge and skills to review and analyze large volumes of client records, investigate coverage to determine primacy, and initiate coverage updates that maximize revenue for our clients. Demonstrates strength of knowledge and skills by adapting quickly to add value to various client programs, consistently exceed productivity and quality results, as well as identify and resolve non-standard eligibility updates and primacy issues that drive revenue. The level II Analyst may contribute to continuous improvement projects or new client programs.

Essential Duties

• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• 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.
• Successfully completes, retains, applies, and adheres to content in required training as assigned.
• Educate Healthcare Insurance carriers, employers, and/or providers on the Coordination of Benefits Rules, and demonstrates ability to respond to complex questions.
• Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making.
• 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.
• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• Communicate effectively with carriers to update validated eligibility records and primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Notes:
• Performs other duties as assigned.
• Contact Healthcare Insurance carriers, employers, and/or providers regarding eligibility discrepancies.
• 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.
• 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.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Demonstrate ability to routinely identify and solve non-standard and often complex data or record discrepancies and/or issues and successfully navigate to achieve results consistently with scope of assignment including multiple carriers, TPL, and other characteristics. Demonstrates ability apply skills and meet expectations across multiple client programs.
• 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.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Follows and complies with company, departmental and client program policies, processes, and procedures.
• 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.)
• May contribute to ideas and approaches to further the enhancement of our products and services, workflows, documentation and training.
• Serves as a positive example and upon request, able to assist representatives and junior analyst team members to answer questions and assist in knowledge/skill enhancement.
• May partner with Sr. Analysts or management to contribute to various projects, continuous improvement efforts, training materials, or development for new client programs.
• May contribute to quality review activity upon management request.

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 Performant’s 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

• Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members.
• Intermediate to advanced Microsoft Excel skills.
• Proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.
• 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 consistently perform job responsibilities.
• Ability to obtain and maintain client required clearances as well as pass company required background and/or drug screening.
• Ability to communicate professionally and effectively with providers, carriers, beneficiaries, and other audiences regarding eligibility and/or Coordination of Benefits (COB).
• Proven strength in researching uncovering eligibility details and resolving data errors leveraging strong analytical skills, ability to interpret and apply a wide variety of policies and information that contributes to identifying what information sources to research and approach to asking questions to seek applicable information from diverse sources, and unwavering professional persistence in obtaining the full scope of data and analyzing to routinely resolve non-standard and often complex primacy issues.
• Strong knowledge and material on-point experience with Healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovering and/or researching the same.
• 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.
• Demonstrated expertise in Eligibility and all related facets relevant to Commercial Third-Party Liability (TPL) aligned with Performant’s client programs that results in ability to identify and resolve non-standard and complex primacy/eligibility errors that results in revenue restoration for our clients.
• Demonstrates high degree of critical thinking and analytical accuracy required to be successful in the role.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change.
• Protect patients’ privacy, understands and adheres to HIPAA standards and regulations.
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
• 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.
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude; develops positive rapport with clients.
• Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.

Physical Requirements

• Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
• 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.
• Reads and comprehends information in electronic (computer) or paper form (written/printed).
• 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.
• 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.
• Occasionally lift/carry/push/pull up to 10lbs.
• 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.

Education And Experience

• High School diploma or GED; some college preferred: equivalent combination of education and related experience.
• Experience must demonstrate consistent ability to independently deliver high volume quality results over a sustained period in a similar function, and large volume portfolio of diverse scope with
• Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or complex problem solving.
• Minimum 4 years of directly relevant 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.

Other Requirements

• Must submit to and pass drug screen pre-employment (and 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 pre-hire background check, as well as additional checks 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.

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