Claims Recovery Analyst
2 weeks ago
Position Title:
Claims Recovery Analyst
Department:
Credit Balance Management
Location:
San Antonio, Texas (on-site)
Reports To:
Senior Manager, Patient Account Services
FLSA Status:
Non-exempt
Position Overview:
The Claims Recovery Analyst is tasked with overseeing the management of overpayment inquiries and the recoupment process within the Radiology billing division.
This role necessitates the use of specialized portals to manage documentation related to overpayment claims, ensuring prompt responses and confirming that adjustments are accurately recorded in accordance with established fee schedules.
The analyst must possess a comprehensive understanding of bundling, Multiple Procedure Payment Reduction (MPPR) adjustments, multiple surgical adjustments, and pertinent fee schedules.
This position requires close collaboration with various departments to effectively address and resolve overpayment challenges.Key Responsibilities:
- Administer and process overpayment inquiries via designated insurance company portals.
- Guarantee that all overpayment claims are managed in a timely and precise manner.
- Monitor and document overpayment cases to ensure thorough documentation and resolution.
- Review and manage documentation for overpayment claims, ensuring accuracy and completeness.
- Prepare and submit necessary supporting documents, including medical reports and coordination of benefits.
- Maintain organized records of all overpayment transactions and communications.
- Respond to overpayment inquiries and related requests in a timely manner.
- Ensure that all required information is submitted within the designated timeframe to facilitate claim resolution.
- Acquire and apply knowledge of bundling, MPPR adjustments, and multiple surgical adjustments.
- Review recoupments automatically deducted from payments by insurance providers to ensure no prior documentation is missing.
- Identify the appropriate department for processing each recoupment case.
- Verify that adjustments are recorded accurately according to the relevant fee schedules within our Billing System.
- Ensure compliance with current fee schedule guidelines for all billing adjustments.
- Collaborate with various internal departments to manage and resolve overpayment and recoupment matters.
- Communicate effectively with insurance companies to resolve discrepancies and obtain necessary information.
- Identify opportunities for process enhancements to improve the efficiency and accuracy of overpayment management.
- Provide insights on improving policies and procedures related to overpayment and recoupment handling.
- Generate reports on overpayment and recoupment activities, summarizing key metrics and trends.
- Report on the status of overpayment resolutions and any challenges encountered during the process.
- Conduct outbound calls to patients to address any requests or issues.
- Assist as a backup for Cashier duties as needed.
- Required to meet departmental quality and productivity standards.
- Contribute positively to the team culture.
- Perform additional duties as required.
Supervisory Responsibilities:
None
Experience / Skill Requirements:
- Excellent written and verbal communication abilities.
- Strong organizational skills with the ability to prioritize tasks.
- Minimum of 6 months of experience in medical billing, particularly in managing overpayments and recoupments.
- Proficient computer skills, including Google Suite or similar software.
- Typing speed of at least 30 wpm and proficient in 10-key by touch.
- Ability to read and interpret explanation of benefits (EOBs).
- Deliver quality customer service through problem-solving and decision-making.
- Must be capable of multitasking and working collaboratively as part of a team.
- Maintain confidentiality at all times.
- Perform additional duties as required.
Education:
High School Diploma or GED required; Associate's degree preferred.
Attendance / Work Schedule:
Maintaining and satisfying minimum attendance requirements is essential for this position, including working all full-time regular hours as established and scheduled or emergency overtime.
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