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Healthcare Insurance Analyst

2 months 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:
Founded in 2010, iHealth Labs Inc is committed to enhancing health and wellness through innovative healthcare solutions. We specialize in developing user-friendly, mobile healthcare products that connect through the cloud, enabling individuals to monitor, track, and share their health data seamlessly with healthcare providers. Our mission is to provide high-quality, accessible health products and services, positioning us as leaders in the digital health sector.

Position Summary:
This role involves comprehensive analysis of health insurance payers concerning medical billing and reimbursement processes. The specialist will oversee payer research and manage complex changes within the payer landscape that affect iHealth's revenue cycle for services such as Remote Patient Monitoring, Chronic Care Management, and Medical Nutrition Therapy.

Key Responsibilities:

  • Conduct thorough health insurance payer analysis related to medical billing and reimbursement.
  • Research and stay updated on significant trends in the healthcare payer industry.
  • Define and communicate payer policies, coverage details, and payment rates for medical procedures.
  • Inform stakeholders promptly about policy updates and changes.
  • Annually review and update payment rates for CPT/HCPCS codes.
  • Implement assigned projects and resolve operational issues effectively.
  • Meet deadlines in a fast-paced project environment.
  • Create and maintain a payer coverage dashboard highlighting benefits and payment rates.
  • Enhance payer relationships by keeping abreast of policy changes.
  • Ensure compliance with regulations set by Medicare, state programs, and other health plans.
  • Engage in the complete revenue cycle management process, including eligibility verification, authorization, charge entry, claim submission, payment posting, and accounts receivable management.
  • Analyze EOBs and ERAs to ensure accurate billing.
  • Follow up with insurance companies regarding denials and coverage issues.
  • Develop and implement departmental procedures to enhance efficiency.
  • Analyze revenue data to identify trends and areas for improvement.
  • Ensure compliance with healthcare billing regulations and stay updated on coding guidelines.
  • Conduct audits and maintain organized documentation of billing activities.
  • Provide training on payer coverage to internal teams.
  • Collaborate with IT to implement enhancements for billing efficiency.
  • Maintain comprehensive records of all billing and invoicing activities.
  • Support other departments through collaboration and teamwork.
  • Adhere to HIPAA regulations and maintain confidentiality.
  • Perform additional duties as required.

Qualifications:

  • Bachelor's degree in accounting, healthcare administration, finance, business, or a related field, with a minimum of 5 years of experience in a healthcare setting.
  • Familiarity with CPT/ICD-10/HCPCS codes and electronic health record systems.
  • Proficient in medical terminology and various insurance plans.
  • Experience in process improvement, data analysis, and reporting.
  • Strong attention to detail and ability to manage multiple databases.
  • Excellent communication skills, both verbal and written.
  • Strong organizational skills and ability to prioritize tasks effectively.
  • Proficient in Google Workspace and Microsoft Office Suite.

Equal Opportunity Employer:
iHealth Labs Inc is dedicated to fostering a diverse workforce and is proud to be an equal opportunity employer. We consider qualified applicants without regard to race, color, religion, gender, national origin, age, disability, veteran status, marital status, or any other legally protected class.