Provider Service Analyst, Medicaid - Tucker, GA - Local Remote

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Summary

We are seeking a talented individual for a Provider Services Analyst – Medicaid who provides on-site and remote account analysis for identifying and recovering client overpayments made to healthcare providers. Responsible for provider outreach and scheduling on-site reviews. Responsible for developing and managing Provider relationships, working independently to identify and secure Provider refunds. Explains audit policies and procedures to the provider; conducts exit conferences to review findings, and reschedules subsequent audits. Responsible for providing successful field and remote performance within assigned territory.

Your role in our mission

• Provides on-site and remote financial account analysis; analyzes the following situations to identify instances of overpayments and clarifies discrepancies:  
• Payment received by more than one payor
• Retroactive payments  
• Double billing/payments
• Inaccurate postings
• Charges written off in excess of amounts actually billed
• Debit contractual adjustments
• Reclassification of accounts
• Charges removed
• Provider A/R collection systems modeling net revenue at the time of billing  
• Incorrect coordination of benefits
• Payments made outside of payer specific guidelines/parameters  Analyzes provider Aged Trial Balance and Debit Adjustment reports and   determines what claims will be reviewed during audit.
• Schedules, provides follow up and communication with provider personnel throughout duration of review.
• Identifies refund trends that can be applied across contract base to maximize revenue and makes recommendation for data mining projects.
• Provides credit balance worksheets and/or summary reports for each review conducted to providers and internal staff, as required.  

What we're looking for

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• 1+ years of healthcare billing experience, audit or collection and accounts receivable experience in a healthcare environment preferred, but not required
• Ability to function effectively under pressure and deadline oriented project demands as well as manage multiple initiatives.  
• Ability to analyze information, use logic and processes to overcome obstacles and resolve problems.  
• Ability to multi-task, establish priorities, and work independently to meet objectives.  
• Ability to work proficiently with Microsoft Word and Excel.
• Ability to quickly gain a sound foundation of knowledge of the various major provider accounts receivable systems.  
• Ability to work effectively in both team and independent environments.  
• Ability to follow instructions and established work protocols. Ability to organize well.  
• Ability to be versatile and easily adaptable to new regulations and rules from client to client.  
• Ability to assimilate to diverse national payer standards, per client needs.
• Ability to remain knowledgeabl