Provider Services Analyst I

About the Role

The Provider Services Analyst I role is a key part of the company's mission to facilitate collaboration between payers and providers, ultimately improving access to healthcare. As part of this team, you will be working closely with cross-functional stakeholders to ensure seamless workflows and alignment with common goals. Your analytical mindset, attention to detail, and excellent communication skills will be essential in navigating the complexities of the healthcare industry.

What You Will Do

• Analyze claims to determine the validity of recovery options
• Draft detailed and convincing correspondence to effectuate reimbursement
• Contact insurance carriers, patients, attorneys, and employers to facilitate reimbursement
• Interpret contracts and payer responsibilities to ensure compliance
• Utilize payer portals and other technologies to advance time to revenue
• Identify defined root causes and trends from client inventories to formulate recovery resolutions
• Clearly and concisely document all actions taken to resolve each claim
• Maintain quality service by following corporate customer service practices and protocols
• Collaborate with internal stakeholders to ensure alignment with common goals
• Stay up-to-date with industry developments, regulations, and best practices

What We Are Looking For

• Prior experience reviewing, processing, and recovering inpatient or outpatient clinical/technical post-service denials
• Knowledge of payer requirements, including appeal guidelines and timeframes
• Familiarity with UB04s and Claim Adjustment Reason Codes (CARC) and Reason Adjustment Reason Codes (RARC)
• Ability to resolve claims by composing compelling appeal letters and guiding resolution of non-routine claims
• Experience navigating EMRs (Cerner, Epic, etc.) and patient financial systems
• Strong analytical, critical thinking, and problem-solving skills
• Excellent verbal, written, and customer service skills
• Ability to work independently and as part of a team
• High school diploma with some college; experience within the healthcare market preferred

Nice to Have

• Experience in navigating EMR and Patient Financial related software support systems
• Familiarity with Microsoft Office products
• Knowledge of medical terminology used in administrative and clinical documentation
• Experience working in an acute care or outpatient environment of revenue cycle
• Certification in a related field, such as medical billing or coding

Benefits and Perks

• Competitive salaries
• Comprehensive health insurance
• 401(k) plan with employer match
• Paid parental leave
• Opportunity to work in a dynamic, growing organization
• Collaborative and innovative work environment
• Professional development opportunities
• Flexible remote work arrangements
• Access to cutting-edge technologies and tools

• Familiarize yourself with the company's mission and values to demonstrate your passion for the role.
• Highlight your analytical and problem-solving skills, as well as your experience with claims analysis and denial resolution.
• Prepare examples of successful appeal letters or claims resolutions to showcase your expertise.
• Be prepared to discuss your knowledge of industry regulations, such as HIPAA, and how you ensure compliance in your work.
• Research the company's technology stack and be prepared to discuss your experience with similar systems.
• Consider creating a portfolio or examples of your work to demonstrate your skills and experience.