Claims Analyst I (US Remote)

📋 Description

• • As a Claims Analyst I at TREND Health Partners, you will play a pivotal role in our mission to revolutionize payment integrity within the healthcare industry. You will be instrumental in identifying, analyzing, and recovering claim overpayments for our esteemed clients, which include major commercial health insurance companies and state healthcare programs. Your work directly contributes to reducing waste, improving healthcare access, and fostering a more collaborative environment between payers and providers.
• • This role is designed for an individual with a keen eye for detail, strong analytical capabilities, and a commitment to accuracy. You will dive deep into complex claims data, system information, and various client documents to uncover potential overpayments. This involves not only applying established methodologies but also contributing to the development of innovative approaches to identify financial discrepancies.
• • Your core responsibility will be to meticulously research and analyze claims data for your assigned clients. This includes understanding the intricacies of different claim types, coding practices, and payer policies. You will utilize our advanced technology platform and proprietary tools to scrutinize claim submissions, identify patterns of error, and quantify potential overpayment amounts.
• • You will be tasked with developing new concepts or adapting existing strategies to effectively identify claim overpayments. This requires a proactive mindset and the ability to think critically about how claims are processed and paid. Your insights will help refine our payment integrity solutions and enhance the value we deliver to our clients.
• • Ensuring the accuracy and timeliness of all claim analysis activities is paramount. You will manage your workload efficiently, prioritizing tasks to meet deadlines and maintain the highest standards of quality. This involves thorough documentation of your findings, clear communication of your analysis, and diligent follow-up on all identified overpayments.
• • Collaboration is key to success at TREND Health Partners. While this is a remote position, you will work closely with internal teams, including other analysts, account managers, and our technology specialists. You will share your findings, discuss potential strategies, and contribute to a collective effort to achieve optimal results for our clients.
• • You will be responsible for preparing detailed reports and summaries of your findings. These documents will be used to communicate the results of your analysis to clients, outlining the identified overpayments, the rationale behind the findings, and the proposed recovery actions. Clarity, conciseness, and accuracy in your reporting are essential.
• • This role offers a unique opportunity to gain in-depth knowledge of the healthcare payment landscape, including reimbursement methodologies, regulatory requirements, and common industry challenges. You will continuously expand your expertise in payment integrity and contribute to the ongoing success of TREND Health Partners.
• • By diligently performing your duties, you will directly impact our clients' financial health by recovering significant overpayments. This not only benefits the payers but also contributes to a more sustainable healthcare system by reducing unnecessary costs.
• • You will be expected to maintain a high level of productivity and efficiency while working remotely. This requires self-discipline, excellent time management skills, and the ability to stay focused and motivated in an independent work environment.
• • The Claims Analyst I position is an excellent entry point into the specialized field of payment integrity. You will receive comprehensive training on our systems, processes, and the specific nuances of healthcare claims analysis, setting you up for a successful career path within our organization.
• • Your role involves understanding and applying various payment integrity concepts, such as duplicate payments, coding errors, contract compliance issues, and medical necessity reviews, all within the framework of identifying and recovering overpayments.
• • You will be a guardian of financial accuracy for our clients, ensuring that payments made for healthcare services are appropriate and in line with contractual agreements and regulatory guidelines.
• • The ability to interpret complex policy documents, provider contracts, and Explanation of Benefits (EOBs) will be crucial in substantiating your findings and building a strong case for overpayment recovery.
• • You will contribute to the continuous improvement of our analytical models and processes by providing feedback based on your real-world analysis experiences.
• • Ultimately, your success in this role will be measured by your ability to accurately identify and quantify claim overpayments, contribute to successful recovery efforts, and maintain strong client satisfaction through diligent and professional work.