Healthcare Collections Analyst

TBC Corporation • Remote - Pennsylvania, PA

5d

About The Position

The Healthcare Collections Analyst is responsible for processing medical insurance claim overpayments that were identified through Lyric’s data mining efforts including but not limited to posting recoveries, processing adjustments and offsets, and conducting collection activities to secure refund checks. The Healthcare Collections Analyst will also participate in validating the overpayments based on policy instructions and claim coding details and will maintain a library that includes instructions for validating specific audit concepts, client specific rules, and system processing instructions. This person may also assist in the identification process and audit concept improvements to ensure the best return for our clients.

Requirements

• Minimum of one (1) year experience in administration support or data entry.
• High school diploma.
• Applicants must already be legally authorized to work in the U.S. Visa sponsorship/sponsorship assumption and other immigration support are not available for this position.

Nice To Haves

• One (1) year experience in healthcare claims operations environment.
• College degree in role related field.
• Excellent communication skills; verbal and written.
• Strong MS Office skills (Word, Excel, PowerPoint).
• Strong organization and time management.
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities.

Responsibilities

• Perform a variety of support and general administration assignments in support of the team including but not limited to data entry, tracking correspondence, generating, stuffing, and mailing letters.
• Process overpayments (post provider refunds, adjustments, offsets) requests, prepare notification letters.
• Conduct outbound calls to healthcare providers to request payment recovery in a professional, courteous, and respectful manner.
• Clearly communicate payment requests, claim details, and supporting information to provider offices.
• Collaborate with internal teams to resolve discrepancies or provider questions efficiently.
• Review claims for missing or incomplete information, calculate payment, or validation of identified overpayments.
• Work under direct supervision with ability to analyze claim issues from identification to resolution and handle basic problems independently while collaborating with senior team member on more complex issues.
• Responsible for reviewing and managing outstanding accounts receivable with guidance by operation leader, contacting providers to collect payment, and identifying issues with unpaid accounts.
• Understand client specific policies related to claim payments, provider manual and member benefits. Maintain legal compliance by following company policies, client policies, procedures, guidelines, as well as state and federal regulations.
• Recognize and report system issues.
• Prepare basic internal and external reports by collecting, analyzing, and summarizing information.
• Maintain productivity goals and standards set by the department.
• Executes functions with focus on accuracy and quality.
• Complete special projects as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED