Insurance Claims Analyst II

3 weeks ago

Liberal, Kansas, United States Navient Full time

Navient offers a comprehensive benefits package including Medical/Dental/Vision, Generous Paid Time Off, Paid Holidays, Tuition Reimbursement, 401k plan with Employer Match, and Professional Development opportunities. Navient, a leader in the revenue cycle management sector, is recognized nationally for providing extensive revenue cycle solutions tailored for healthcare institutions. Our primary focus is on enhancing healthcare revenue cycles, leveraging over 30 years of dedicated experience across all 50 states.
Navient is committed to delivering solutions that address the diverse revenue cycle needs of our clients.

Our approach emphasizes both clinical and financial interoperability to optimize the collection of net revenue.

Navient offers a variety of services including full and partial revenue cycle outsourcing, third-party insurance follow-up, self-pay management, coding, Clinical Documentation Improvement (CDI), and consulting services.


POSITION SUMMARY:

The Insurance Claims Analyst II will be tasked with the review and resolution of outstanding insurance balances associated with patient accounts from hospitals or physicians.

This role requires adaptability in learning and understanding complex hospital systems, along with strong analytical skills to determine the appropriate actions needed to resolve aged account receivables.

The Analyst will be responsible for ensuring that cash recovery targets are achieved and that assigned hospital receivables are addressed in accordance with company, client, and federal guidelines.


KEY RESPONSIBILITIES:

  • Effectively manage assigned insurance receivables to meet business line expectations.
  • Achieve productivity standards as defined by the business line.
  • Maintain a minimum of 85% quality scoring and accuracy on all accounts processed.
  • Conduct timely follow-ups on assigned accounts to prevent cash loss.
  • Meet monthly cash recovery goals for assigned client receivables.
  • Resolve insurance accounts within 90 days of assignment.
  • Demonstrate the ability to prioritize tasks with minimal oversight to achieve set objectives.
  • Perform account research and navigate accounts through appropriate client workflows.
  • Possess a strong understanding of patient accounting systems to facilitate smooth transitions and learning of new systems as required.
  • Document actions taken and next steps for account resolution in the patient accounting system clearly.
  • Exhibit excellent knowledge of the Prism system, including claim updates, request workflows, and action step entries.
  • Request necessary documentation based on account needs and compliance standards.
  • Navigate billing systems to execute basic claim billing functions.
  • Prepare appeals for payment to insurance companies when warranted.
  • Communicate effectively to convey detailed account information.

COMPLIANCE AND EDUCATION:

  • Ensure all accounts are managed in accordance with client standards and federal regulations.
  • Maintain high-quality account handling per client specifications.
  • Adhere to federal and state regulations, as well as all compliance policies.
  • Document all attempts and contacts made for accounts accurately and concisely.
  • Engage in ongoing education and training for career development.
  • Stay informed of and comply with all federal and state regulations governing collections and communications, including HIPAA, FDCPA, Privacy Act, and FCRA.
  • Participate in training sessions as directed by management.
  • Incorporate information gained from training and policy updates into daily operations promptly.

MINIMUM QUALIFICATIONS:

  • High school diploma (additional relevant experience may substitute for educational requirements).
  • At least 1 year of experience in healthcare accounts receivables billing (additional relevant education may substitute for experience).
  • Strong oral and written communication skills.
  • Basic computer proficiency.

PREFERRED QUALIFICATIONS:

  • Experience in hospital billing.
  • Strong organizational, planning, and prioritization skills.
  • Effective communication abilities.
  • Data management proficiency.
  • Attention to detail and accuracy.
  • Problem-solving skills.

All employment offers are contingent upon standard background checks. Navient and its affiliates are federal, state, and/or local government contractors. Candidates may be subject to background checks for eligibility and suitability for federal contract employment. Navient is an equal opportunity employer, committed to diversity and inclusion.

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