Jr. Financial Recovery Analyst

Regal Medical Group•Los Angeles, CA

1d•Onsite

About The Position

This role is responsible for generating additional income, savings, and reducing expenses for Regal Medical Group through the recoupment and recovery of various programs and products. Key responsibilities include auditing capitation deductions, disputing unwarranted deductions, managing overpayments, collaborating with various departments and health plans, and maintaining accurate records in EZCAP. The analyst will also be involved in creating and updating the Division of Responsibility Grid (DOFR), reviewing benefit matrices, implementing new revenue recovery projects, and liaising with health plans regarding stop-loss information. The position requires a strong understanding of healthcare regulations, coding, and contract interpretation.

Requirements

Two (2) years college or equivalent experience is required
Minimum of 5-year Claims/Benefits/DOFR/Contracts experience in a medical group, Hospital and/or health plan setting is required.
Ability to deal responsibly with matters of a confidential nature.
Ability to prioritize work in order to meet daily deadlines.
Must have excellent communication skills, both verbal and written.
Ability to read, write and understand the English language.
Pleasant telephone manner in recovering overpayments from providers.
Knowledge of HMO, DHS, DMHC, and CMS regulatory guidelines.
Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding.
Knowledge of HMO, DHS, DMHC, and CMS claims processing guidelines.
Strong knowledge of Microsoft Windows environment such as Word and Excel.
Self-starter, willing to take on multiple tasks.
Must be able to review and interpret health plan benefits and provider contracts.
Able to interface with customers both internal and external of RMG.
Ability to communicate effectively orally and written typing 35 words per minute.
Ability to communicate effectively orally and written answering and resolving 60 to 65 calls per day.
Strong organizational skills with emphasis on prioritizing and attention to details.

Responsibilities

Audit all capitation deductions submitted by all the health plans on a monthly basis.
Dispute unwarranted capitation deductions for each health plan.
Send overpayments to the provider of service when capitation resulted in duplicate payments.
Collaborate with Quality Control, Audit, and Claims department for any health plan issues and provide resolution.
Collaborate with HPN if credits were received as a result of disputes presented to the health plans.
Ensure Inload of Cap Deducts in EZCAP and entries of recoveries are made.
Act as liaison to the health plan if there are any capitation deduction issues brought by HPN/RMG.
Refer to division head health plan issues or other department concerns that are not within the parameters of the internal procedures we have established on capitation deduction.
Recoup from Lakeside overpayments if the HMO coordinator cannot tackle the heavy work exigencies.
Review co-pay reports Institutional and Professional when time permits.
Review LMG Capitation report when threshold of inventory on LMG side persists.
Initiate new DOFR Grid for new Medical Group that we acquire.
Update existing internal DOFR for the use of HPN, RMG, LMG, ADOC, GCMG.
Configure DOFR in EZ-CAP for RMG, LMG, GCMG, & ADOC.
Ensure accuracy of DOFR.
Present to Revenue Recovery Associate any discrepancies found for dissemination to all department heads.
Attend to emails sent by various departments as they relate to inquiries and potential errors in loading DOFR grid.
Review Benefit Matrices and provide input to the division head for preparation of policy and procedures and/or for the use of internal guidelines templates.
Provide historical data of assigned tasks and contractual guidelines to pursue various revenue recovery projects.
Implement new projects as assigned by the division head.
Collaborate with the division head claim issues due to Benefit loading errors.
If the system was loaded incorrectly and claims were paid as a result of this error, recover from the appropriate payor/s.
Request for system change to apply the correct payor’s responsibility.
Review contracts to check if Benefit schedules are loaded accurately.
Present feedback to RRA.
Participate in the creation and preparation of new departmental policies and procedures.
Liaison to Madison Healthcare Insurance Services when they need additional information with regard to Stop Loss.
Audit special projects as assigned by the division head.
Analysis special projects as assigned by the division head.
Health plan disputes special projects as assigned by the division head.
All other duties as directed by management.