Medical Expense Recovery Analyst

1 week ago


New York, New York, United States Athari Full time
Athari: Enhancing Medical Expense Recovery

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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