Eligibility and Recovery Claims Lead

📋 Description

• • As the Eligibility and Recovery Claims Lead at Performant Corporation, now part of the Machinify organization, you will play a pivotal role in optimizing healthcare payment processes through advanced expertise in eligibility, claims, and recovery operations. This remote position offers a unique opportunity to leverage your deep understanding of healthcare data and regulations to drive efficiency, accuracy, and value for health plans across the nation.
• • You will be instrumental in supporting both new client implementations and enhancing existing programs by conducting detailed analyses of all claiming operations. This includes a thorough examination of outgoing and incoming healthcare Electronic Data Interchange (EDI) transactions, ensuring seamless data flow and compliance.
• • A core responsibility involves utilizing your advanced knowledge of Coordination of Benefits (COB) and Third-Party Liability (TPL) to meticulously review healthcare claims and client data. This analytical work is crucial for identifying trends, patterns, and potential impacts across various product lines, enabling proactive problem-solving and strategic decision-making.
• • You will collaborate closely with technical and business leads, providing essential support in requirements gathering, documentation, and project management for both new implementations and modifications to existing programs. Your insights will directly contribute to the successful deployment and ongoing optimization of our solutions.
• • The role demands a proactive approach to data analysis, employing subject matter expertise, independent judgment, and strong analytical skills to derive intelligent insights. This involves developing custom queries and reports, conducting in-depth research, analyzing trends and activities, and presenting findings clearly and concisely to stakeholders.
• • Your analysis will be critical in identifying opportunities for improvement, pinpointing the root causes of issues, and providing the data-driven evidence needed to support business decisions and strategic initiatives.
• • You will foster a high-performing team through effective leadership, including regular meetings, comprehensive training, ongoing coaching, and mentorship, all aimed at professional development and sustained success.
• • Adherence to company, departmental, and client program policies, processes, and procedures is paramount. You will ensure all operations are conducted in compliance with client requirements, HIPAA regulations, and other applicable federal or state laws, maintaining the highest standards of data security and privacy.
• • Successful completion, retention, application, and adherence to all assigned training content are expected, ensuring you remain up-to-date with industry best practices and regulatory changes.
• • You will be responsible for completing all required processes to obtain necessary client and company clearances, including background checks and drug screenings, as a condition of employment. Maintaining these clearances is essential for ongoing engagement.
• • Demonstrating Performant's core values in all job duties and interactions is fundamental to the role, fostering a positive and ethical work environment.
• • You will be expected to address and correct any areas of deficiency or oversight identified through quality reviews or management feedback, demonstrating a commitment to continuous improvement.
• • This role may involve other duties as assigned, reflecting the dynamic nature of the healthcare intelligence industry and the needs of our clients.
• • By joining Machinify, you become part of a leading healthcare intelligence company dedicated to reshaping healthcare payments through seamless intelligence. Your work will directly contribute to delivering unmatched value, transparency, and efficiency to health plans, impacting over 170 million lives represented by our client base.