Provider Services Analyst I (US Remote)

RemoteFull-Timemid

OtherAnalyst

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Overview

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TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.

Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.

The Provider Services Analyst I’s primary responsibility is to determine denials from remittance /explanation of benefits, trend root cause, and take appropriate steps for resolution by crafting detailed appeal letters and contacting insurance payers for resolution. This individual must be self-motivated and be able to work independently and within a team structure. Ensures legal compliance by following guidelines, account contract, and the company's business plan.

Maintains quality service by following corporate customer service practices and protocols

Analyze claims to determine the validity of recovery options

Draft detailed & convincing correspondence to effectuate reimbursement

Contacting insurance carriers, patients, attorneys, and employers to facilitate reimbursement

Contract interpretation as it relates to reimbursement, timelines, and verbiage of payer responsibilities guidelines to be followed

Use of payer portals and other technologies to advance time to revenue

Be able to identify defined root causes and trends from client inventories to formulate recovery resolutions or next steps in best practices

Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

Prior experience reviewing, processing, and recovering in patient or outpatient clinical/technical post[1]service denials preferred

Multi-state Knowledge of payer requirements preferred but not required specifically in appeal guidelines and timeframes

Knowledge of UB04s and Claim Adjustment Reason Codes (CARC) and Reason Adjustment Reason

Codes (RARC) is preferred

Ability to resolve claims by composing a compelling appeal letter; guiding resolution of non-routine claims; auditing claims with decision resulting in a high overturn rate.

Prior experience navigating EMRs (Cerner, Epic, etc.) and patient financial systems

Thought leader with critical eye for detail

Strong ability to effectively multi-task

Superior verbal, written, customer service, and analytical skills with resolution is preferable.

A continuous drive to stay abreast of healthcare industry policies and regulations

Understanding of medical terminology used in administrative and clinical documentation is preferable

Familiarity with Microsoft Office products

Possession of a High School Diploma with some college

Experience within the healthcare market

Experience in navigating EMR and Patient Financial related software support systems, EPIC and Cerner experience a plus

Previous experience within an acute care or outpatient environment of revenue cycle

This position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.

The nature of the work is sedentary, and the employee will be sitting most of the time.

Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.

Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.

Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information.

Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.

Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.