Medical Expense Recovery Analyst
1 week ago
We are seeking a highly skilled Medical Expense Recovery Analyst to join our team at Athari. In this role, you will be responsible for optimizing medical expense recovery programs.
About the Role:
- Develop a comprehensive strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending by reviewing upstream and downstream processes.
- Identify overpayment/underpayment opportunities through data mining, investigation, and quality review on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
- Support the execution and maintenance of a corporate claim accuracy program by optimizing pre/post claim editing, auditing, and claim recovery programs.
- Manage day-to-day financial recovery vendor relationships, validating that identified overpayments are valid and recouped.
- Assist in the development and implementation of dashboards to monitor performance.
Requirements:
- Bachelor's degree required.
- A minimum of 5 years' working experience within claims in the healthcare or insurance industry.
- Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation.
- Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
Salary Range: $100,000 - $130,000 per year.
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