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 Iâs 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.\nROLE AND RESPONSIBILITIES
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
QUALIFICATIONS
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
MENTAL AND PHYSICAL DEMANDS
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.
RELATED DUTIES AS ASSIGNED
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.
\n$50,000 - $60,000 a year\nPlease mention the word **CHARMINGLY** and tag RMzQuMTMuMjEzLjE3Mg== when applying to show you read the job post completely (#RMzQuMTMuMjEzLjE3Mg==). This is a beta feature to avoid spam applicants. Companies can search these words to find applicants that read this and see they're human.