Eligibility and Recovery Claims Lead

Performant • Plantation, FL

12d • $95,000 - $104,000 • Remote

About The Position

The Eligibility and Recovery Claims Lead will possess advanced knowledge of healthcare eligibility, healthcare claims, medical terminology, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL). This position will also support new client implementations and existing programs with detailed analysis of all claiming operations, including but not limited to outgoing and incoming healthcare EDI transactions.

Requirements

• Knowledge of and ability to work with large volumes of health care claims data.
• Knowledge of healthcare medical and pharmacy claims
• Experience with Medicaid / Medicare / Other TPL business models and products
• Knowledge of requirements gathering, ETL processing and data matching
• Strong system skills with ability to quickly develop expertise in new systems and applications
• Advanced skills in Excel, Access and/or other data analysis applications
• Proficient SQL skills to query and test
• Advanced knowledge of X12 EDI Transactions, including, but not limited to 270/271, 277, 837, 835, 834
• Professional verbal and written communication with good presentation skills
• Able to work independently and meet deadlines with minimal supervision
• Strong problem solving and communication (written and oral) skills
• Ability to produce results and maintain positive attitude in fast paced, dynamic environment
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail
• Bachelor’s degree in relevant field, or equivalent combination of education and experience may be considered
• 7+ years relevant experience working with healthcare claims data.
• 3+ years management or supervisory experience
• Advanced knowledge and experience with healthcare claim operations, Coordination of Benefits, and Third Party Liability

Responsibilities

• Leverage knowledge and expertise in COB and TPL review healthcare claims and client data.
• Review and analyze client data to identify trends, patterns and identify impact across various products.
• Assist technical and business leads with requirements gathering, documentation, and project management for new implementations and existing program changes.
• Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.
• Develops custom queries and reporting, conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.
• Collaborates with leadership to provide effective and detailed analysis required for optimal business operations.
• Maintains a strong team through meetings, training, coaching, mentoring and other development techniques.
• Follows and complies with company, departmental and client program policies, processes, and procedures.
• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• Successfully completes, retains, applies, and adheres to content in required training as assigned.
• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains. clearances statuses as a condition of employment. (Note: client/government clearance requirements are not determined or decisioned by Performant.)
• Demonstrates Performant core values in performance of job duties and all interactions.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Other duties as assigned.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level