Healthcare Insurance Analyst

2 weeks ago

Sunnyvale, California, United States Ihealth Labs Inc Full time
Job Overview

Location: Remote

Compensation: Competitive hourly rate based on experience

Employment Type: Full-Time

About iHealth Labs Inc:

Established in 2010, iHealth is committed to enhancing the health and well-being of individuals. As a pioneer in developing user-friendly, mobile healthcare solutions that connect through the cloud, iHealth enables users to effortlessly monitor, record, and share critical health data with their healthcare providers. Our mission focuses on providing high-quality, accessible healthcare products, positioning iHealth at the forefront of the digital health transformation.

In 2018, we launched the Unified Care initiative to tackle chronic disease management. Our specialists assist patients beyond clinical settings through Chronic Care Management (CCM) and Remote Patient Monitoring (RPM), striving for improved health outcomes.

In November 2021, our COVID-19 Antigen Rapid Test received Emergency Use Authorization (EUA) from the U.S. FDA for over-the-counter distribution. Since then, iHealth has become a vital supplier of at-home COVID tests to various governmental and nonprofit organizations, as well as individual consumers. Our dedication to promoting healthier living continues to drive innovation in the healthcare sector.

Position Summary:

This role entails comprehensive analysis of health insurance payers concerning medical billing and reimbursement processes. The specialist will oversee all facets of payer research, effectively communicate and manage intricate payer and industry modifications that influence iHealth's revenue cycle related to Remote Patient Monitoring, Chronic Care Management, and Medical Nutrition Therapy services.

Key Responsibilities:

  • Conduct thorough health insurance payer analysis regarding medical billing and reimbursement.
  • Research and monitor key trends in the healthcare payer landscape at both macro and micro levels.
  • Define payer policies, coverage details, and payment rates for various procedures.
  • Timely update internal and external stakeholders on policy modifications.
  • Annually revise insurance payment rates for each CPT/HCPCS code.
  • Implement assigned projects and resolve operational issues efficiently.
  • Adhere to tight deadlines in a fast-paced project environment.
  • Create and maintain a payer coverage dashboard showcasing benefits and payment rates.
  • Enhance payer relationships by staying informed on policy changes.
  • Ensure compliance with regulations set by Medicare, state programs, and HMO/PPO entities.
  • Engage in the complete revenue cycle management process, including eligibility verification, authorization, charge entry, claim submission, payment posting, and accounts receivable management.
  • Analyze EOB and ERA documentation.
  • Follow up with insurance companies and medical groups to resolve denials and coverage issues.
  • Develop and implement departmental procedures and processes.
  • Generate reimbursements and analyze revenue data to identify trends related to errors and denials.
  • Utilize data mining skills to pinpoint areas for improvement and revenue growth opportunities.
  • Optimize revenue capture and minimize revenue leakage.
  • Maintain compliance with healthcare billing regulations and stay updated on billing and coding guidelines.
  • Conduct detailed audits and data clean-up as necessary.
  • Provide payer coverage training for internal stakeholders and document training sessions.
  • Implement strategies to enhance claim acceptance rates and reduce denials.
  • Collaborate with IT teams to integrate technology improvements that boost billing and revenue efficiency.
  • Maintain organized records of all billing and invoicing activities.
  • Manage invoicing and track incoming and overdue payments.
  • Work collaboratively with internal teams to support departmental needs.
  • Ensure compliance with HIPAA regulations.
  • Act as a gatekeeper for payer research and knowledge.
  • Perform additional related duties as assigned.

Minimum Qualifications:

  • Bachelor's degree in accounting, healthcare administration, finance, business, or a related field, with a minimum of 5 years of experience in an office or healthcare environment.
  • Familiarity with CPT/ICD-10/HCPCS codes and EHR systems.
  • Proficient understanding of medical terminology and insurance plans.
  • Experience in process improvement, quality control, data analysis, and reporting.
  • Integrity and respect for confidentiality.
  • Strong attention to detail and ability to work with diverse databases.
  • Leadership capabilities, including effective communication of payer knowledge.
  • Ability to work independently, demonstrating self-motivation and excellent verbal and written communication skills.
  • Strong organizational and time management skills to prioritize tasks effectively.
  • Proficient in problem analysis and strategic solution development.
  • Advanced computer skills, including proficiency in Google Docs, Sheets, Slides, and Microsoft Office Suite.

Equal Opportunity Statement:

iHealth Labs is dedicated to fostering diversity within its workforce and is proud to be an equal opportunity employer. We consider qualified applicants without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, marital status, pregnancy, sex, gender expression or identity, sexual orientation, citizenship, or any other legally protected status.

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