Overpayment Recovery Analyst

by Irma Moore | May 17, 2024 | Uncategorized

• Follow up of overpayment requests which may include discussions with Administrator, Claim Analyst, Broker both internal and external customers via conversation and/or letters, ability to provide detailed descriptions of circumstances around overpayment and provide specific details from claim files, conduct discussions with internal claims analysts
• Provide monthly current recovery reports (analysis, trending, actions, status), contacting external customers (Administrator/Broker/outside collection agency)
• Receive escheatment report, investigate customer data and provide data to banking for potential stop pay/re-issue of checks

What you will bring with you:

• Ability to work with a diverse range of people
• Requires expert level understanding of the Stop Loss claims process or Medical Claims with respect to how overpayments are determined, processes for write offs, succinct, detailed communication to external customers requesting monies. 
• 5+ years understanding of first dollar stop loss claims or medical claims, Prior experience in medical or Stop Loss claim adjudication

 Information Technology Program Manager

by Irma Moore | May 17, 2024 | Uncategorized

Sr. DME Billing Integrity Analyst

by Irma Moore | May 17, 2024 | Uncategorized

What You Will Do

• Assist in the monthly statement audit review for new vendors and markets, with special focus on new rentals and first-time mail-order product deliveries and shipments.
• Conduct monthly pre-billing reviews and data quality analysis to ensure that statements delivered to our vendors are accurate. 
• Receive, track and process vendor adjustments to ensure month end statements are correct and paid timely.
• Compares patient billed charges to vendor statement line items and performs contractual and payor reviews to identify, analyze and mitigate billing risks. 
• Manage and complete special billing projects to ensure deadlines are met, audits are completed successfully and for non-supported systems, which requires manual updates and oversight. 
• Creates and develops reports to address management needs; analyzes information to identify trends or issues and recommends process improvements as appropriate. Implement changes as approved.
• Acts as a central point of contact on vendor billing related matters for various internal departments including but not limited to Accounting, Network, Fulfilment Operations, Vendor Services and Operations.
• Partnering with vendor ops team (vendor recruitment and implementation team) to update/maintain system of record for vendor statement information (pricing, terms, etc.).
• Bachelor’s degree in business, Accounting, Finance, or related field.
• At least 5 years’ in accounts payable role including 2 years’ experience in the healthcare industry with Durable Medical Equipment (DME)  operations/billing experience.  Preference will be given to candidates with experience/knowledge of HCPCS from a supplier’s perspective. 
• Demonstrate organizational skills.
• Demonstrate effective verbal and written communication skills.
• Demonstrate analytical skills when problem-solving.
• Demonstrate high attention to detail and a high degree of accuracy.
• Support process improvement. 

Appian Software Programmer

by Irma Moore | May 17, 2024 | Uncategorized

• Designs and codes applications following specifications using the appropriate tools
• Maintains and modifies existing software applications.
• Analyzes detailed systems factors, including input and output requirements, information flow, hardware and software requirements, and alternative methods of problem resolution.
• Performs modifications to and maintenance of operational programs and procedures.
• Participates in code reviews to represent reviewed work for adherence to standards and specifications.
• Writes or revises program documentation, operations documentation and user guides in accordance with standards.

Qualifications

Required Skills and Experience

• Bachelor’s with 8+ years (or commensurate experience)
• 8+ years of experience in production/site-reliability engineering OR 5+ years of server-side software engineering with an interest in working on core infrastructure
• 8 years experience working in a software development environment, including two (2) years specialization in configuration management and Appian BPM product.
• 5+ years of experience with Cloud technology, Amazon AWS specifically: AWS (VPC, EC2, Fargate, S3, EBS, CloudFormation), Terraform, Salt Stack, Git/GitLab, Artifactory, Windows OS, and Linux OS.
• A solid understanding of at least two of: public cloud infrastructure, Linux systems administration, and DevOps tooling.

Remote Medical Accounts Receivable Specialist

by Irma Moore | May 16, 2024 | Uncategorized

• Prepare and submit clean electronic claims to maximize reimbursement.
• Analyze claim rejections and take corrective action to ensure resubmission success.
• Process all incoming payments from insurance and patients, ensuring accurate posting.
• Manage outstanding balances by following up with insurance companies, processing rebills, and escalating complex issues.
• Review and address denied claims, resubmitting when appropriate or initiating appeals.
• Reconcile patient and insurance credit balances to facilitate timely refunds.
• Serve as the first point of contact for patient billing inquiries, addressing concerns and escalating as needed.
• Collect patient co-pays, coinsurance, and deductibles.
• Develop and manage patient payment plans, ensuring timely settlements.

Requirements

• 5 or more years of experience working medical denials
• Experience working in EPIC required
• Experience working with Medicaid and Commercial payors