Senior Healthcare Coordination of Benefits (COB) Analyst

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $47,900- $59,000

The Senior Healthcare Coordination of Benefits (COB) Analyst reviews and analyzes large volumes of client pre-pay and/or post-pay records, investigates coverages for eligibility and determine primacy, educate and resolve discrepancies with insurance carriers, employers, and or providers in order to maximize revenue for our client’s recovery programs.  Additionally, the senior role leverages subject matter expertise and experience to perform a variety of activities and projects such as supporting team development, handling client requests, analysis, and reporting, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs.

Key Responsibilities

• Leverage strong knowledge and expertise in COB/TPL/EOB to gather and review eligibility, investigate policy coverage to determine proper order of benefits and resolve primacy issues that will bring successful payment or other appropriate account action.
• Ability to identify unique trends from payer data in order to isolate policy details to process appropriately per client and business needs.
• Successfully solve complex data or record discrepancies and/or issues.
• Communicate effectively with carriers, employers, and/or providers to determine primacy; answer complex questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems.
• Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers.
• Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) and consistently resolve the most complex eligibility discrepancies and questions.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.
• Supports management with inventory assessment and distribution to team members.
• Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation.
• Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business.
• Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example.
• Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management. 
• Supports team training activities and contributes to development and enhancement of training materials and tools.
• Leads and contributes to ad-hoc projects and initiatives and establishing best practices.
• Consistently maintains regular good attendance, demonstrates professio