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Claims Recovery Analyst

Company: P3 Health Group Management, LLC
Location: HENDERSON
Posted on: May 3, 2021

Job Description:

People. Passion. Purpose. At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. We are looking for a Claims Recovery Analyst.

If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, Nevada, then you should consider joining our team.

Claim Recovery Analyst

Overall Purpose: The main function is to audit professional and facility claims for accurate processing per all contract, health plan, State and Federal regulations within payment compliance time limits. This position will also be responsible for identifying and processing all overpayments/underpayments identified internally or through interface with third party recovery vendors.

Education and Experience:

High school diploma or GED. Some college preferred

Facility Audit Recovery Analyst must have 8 years minimum experience in the Medical Claims payment industry specializing in payment and audit of professional and facility claims

Must have significant experience (6 years minimum) in the Medical Claims payment industry specializing in professional and facility claims processing

Must have analytical and problem-solving skills

Must be able to perform root cause analysis and present findings

Knowledge, Skills and Abilities:

Must have a strong understanding of any local, state and federal rules regarding the adjudication of medical benefits

Personal computer with main frame emulation, claims management software, word processing and management software, Imaging retrieval software, fax machine, copy machine, basic office aids

Working knowledge of HMO operations, claims delegation compliance, and contract interpretation

Strong knowledge of CPT, HCPCS, ICD-10, DRG and APC coding and CMS Guidelines

Strong organizational and time management skills with the ability to prioritize individual workloads

Must have excellent analytical and interpersonal skills

Strong communication and presentation skills

Essential Functions:

Responsible for all actions/responsibilities as described in company controlled documentation for this position

Contributes to and supports the corporations quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporations quality improvement efforts

Conduct pre and post payment audit of professional and facility claims for accurate payment per contract, health plan, State and Federal requirements

Run and analyze reports to identify professional and facility claim over-payments/under-payments and initiate recovery

Interface with third party recovery vendors to identify over-payments and initiate recovery and maintain recovery records per vendor and approve invoices for payment Answer questions for customer service regarding overpayment recoveries

Perform adjustment adjudication for claims under-paid, over-paid, or in some other fashion incorrectly adjudicated

Responsible for all actions/responsibilities as described in company-controlled documentation for this position

Contributes to and supports the corporations quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporations quality improvement efforts

Execute other duties as assigned

Track and trend billing errors and identify fraud, waste, and abuse

Present to leadership as needed on recovery outcomes and projections

EQUAL OPPORTUNITY EMPLOYER

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

DIVERSITY & INCLUSION

At P3, we recognize and appreciate the importance of creating an environment in which all team members feel valued, included, and empowered to do their best work and bring great ideas to the table

Every P3 family member's unique experiences, perspectives, and viewpoints are valued and support our ability to deliver the best possible experience for our patients, providers, payers, partners, and each other.

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Keywords: P3 Health Group Management, LLC, Henderson , Claims Recovery Analyst, Other , HENDERSON, Nevada

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