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Healthcare Insurance Analyst

2 months ago

Sunnyvale, California, United States IntelliPro Group Inc. Full time
Job Overview

Position Title: Healthcare Insurance Analyst

Location: Remote

Compensation: $30 - $40 per hour on W2

Job ID: 139980

Key Responsibilities:

  • Conduct comprehensive analysis of health insurance payers in relation to medical billing and reimbursement processes.
  • Research and stay updated on significant trends affecting healthcare industry payers at both macro and micro levels.
  • Clarify payer policies, coverage options, and payment rates for various medical procedures.
  • Communicate policy changes to both internal and external stakeholders promptly.
  • Annually review and adjust insurance payment rates for each CPT/HCPCS code.
  • Oversee the execution of assigned projects and resolve operational issues effectively.
  • Work under tight deadlines in a fast-paced, resource-limited project environment.
  • Create and maintain a payer coverage dashboard that outlines payer benefits and PFS rates.
  • Enhance payer relationships by remaining informed about policy changes.
  • Ensure adherence to all regulations and guidelines established by Medicare, State programs, and HMO/PPO.
  • Participate in the complete revenue cycle management process, including eligibility verification, authorization, charge entry, claim submission, payment posting, and accounts receivable management.
  • Understand the Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).
  • Engage with insurance companies and medical groups to resolve denials and coverage issues.
  • Develop and implement departmental procedures and processes.
  • Analyze revenue data to identify trends related to errors and denials, and generate reimbursements.
  • Utilize strong data mining skills to pinpoint trends, improvement areas, and revenue growth opportunities.
  • Identify strategies to optimize revenue capture and minimize revenue loss.
  • Maintain compliance with healthcare billing regulations and stay updated on changes in billing and coding guidelines.
  • Conduct thorough data audits and clean-up as required.
  • Provide payer coverage training for internal stakeholders and document training sessions adequately.
  • Implement strategies to enhance claim acceptance rates and reduce denials, improving the overall billing experience.
  • Collaborate with IT teams to integrate technology enhancements that boost billing and revenue efficiency.
  • Keep organized records of all billing and invoicing activities.
  • Manage the invoicing process and track incoming and overdue payments.
  • Work collaboratively with internal teams to support the needs of other departments.
  • Ensure compliance with HIPAA regulations.
  • Act as a custodian of the payer research and knowledge acquired.
  • 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 various insurance plans.
  • Experience in process improvement, quality control, data analysis, and reporting.
  • Demonstrated integrity and respect for confidentiality and privacy.
  • Strong attention to detail and ability to work with diverse databases.
  • Leadership capabilities, including the ability to present and represent payer knowledge effectively.
  • Self-motivated and capable of working independently with excellent verbal and written communication skills.
  • Exceptional organizational and time management skills to prioritize workflow effectively.
  • Excellent customer service skills to ensure client satisfaction.
  • Aptitude for analyzing problems and developing strategic solutions.
  • Strong computer skills, including proficiency in Google Docs, Sheets, Slides, and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel).

About IntelliPro Group Inc.:

Founded in 2009, IntelliPro Group Inc. is a global leader in talent acquisition and HR solutions. Our dedication to providing exceptional service to clients, promoting employee development, and fostering long-lasting partnerships distinguishes us in the industry. With a robust presence across multiple countries, we continue to excel in delivering global talent solutions.

As an Equal Opportunity Employer, IntelliPro values diversity and is committed to inclusivity, ensuring that our hiring and interview processes accommodate all candidates. We welcome applicants from all backgrounds and abilities.

Compensation: The compensation offered to successful candidates will be based on various factors, including education, work experience, location, job responsibilities, and certifications. IntelliPro also provides a comprehensive benefits package, subject to eligibility.