Remote Underpayment Zero Balance Claims Analyst
What is Aspirion?
Aspirion is an industry-leading provider of complex claims management services. We specialize in Motor Vehicle Accidents, Worker’s Compensation, Veterans Administration and Tricare, Complex Denials, Out-of-State Medicaid, and Eligibility and Enrollment Services. Our employees work in an environment that is both challenging and rewarding. We ask a lot out of our team members and in return we offer flexibility, autonomy, and endless opportunities for advancement. As we are committed to growth within the complex claims industry, we offer the same growth to our employees.
What do we need?
We are looking for a talented and proficient Underpayment Zero Sr. Claims Analyst to join our growing team. The Senior Claim Analyst provides high-level claim related functionality in an advanced specialty role for projects. This individual needs to be self-motivated, driven, and have advanced knowledge of revenue cycle operations and claims processes. The Senior Claim Analyst will be tasked with special projects as designated by their management team, assist as an additional knowledge resource for Claim Analyst, and support management team.
What will you provide?
- Works assigned accounts independently, efficiently, toward resolution while maximizing proficiency
- Partner with both internal and external resources to find root cause of claims with adverse financial outcomes to ensure resolution
- Perform on accounts that hold a zero balance to determine if additional payment is needed
- Review contracts for revenue capture and maximize for billing and coding guidelines
- Identify trends in payments amongst payors and reporting trends to management
- Audit closed balance and written off accounts to ensure accuracy of payments to contract.
- Model contract terms, rates, fees, and schedules
- Establish network of working relationships with individuals at insurance companies, negotiate contracts
- Monitor changings in coding schemes
- Prepare and submit correspondence letters, emails, online inquiries, prepare submit payor dispute forms and appeals.
- Proactively identify and manage trends, issues, and maintain written documentation of findings
- Performs analysis of accounts to determine necessary action for resolution of account
- Utilize collection talk off guidelines to resolve accounts
- Contacts payers to obtain payment or status to resolve accounts while maintaining good payer relations
- Contacts patients/guarantors where necessary to verify/gather information to properly handle accounts
- Follows hospital specific processes when returning an account for hospital action (i.e. rebilling, medical records requests, appeals, etc.)
- Update accounts with any new or corrected information received on an account
- Documents in hospital’s collection system all action taken on an account where appropriate
Other duties that may fall under scope:
- Assist team members to clarify assignments, milestones, and deliverables
- Provide research based input
- Assist with project implementation, lead, support or provide specific deliverables ensuring timely project kick-offs
- Assist team members with questions, concerns, and complaints from insurance companies, patients, and other personnel
- Evaluate critical areas of opportunities within existing client scope of services ensuring timely corrective action
- Participate in highly developed strategy and planning sessions with management team
- Maintain a clear project scope and motivate team members
- Maintain a working knowledge of all team operations and associated facility processes
- Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
The following is a list of personal and professional competencies that must be present to succeed in this role.
- Active listening
- Ability to multi-task
- Exceptional phone etiquette
- Strong written and oral communication skills
- Effective documentation skills
- Strong organizational skills
- Service orientation
- Reading comprehension
- Critical thinking
- Social perceptiveness
- Time management and reliable attendance
- Fast learner
Education and Experience
- High School Diploma or Equivalent
- Experience with Microsoft Suite
- Bachelor’s Degree or equivalent experience preferred
- Experience with Medicare, Medicare Advantage, Medicaide, HMO, Managed Care Plans or Commercial Plans, Third party reimbursements for Hospital / Clinics
- Knowledge /experience with UBO4/1500 billing requirements, CCI edits, payer LCD/NCD familiarity, understand EOBs
- Previous experience with hospital based systems (Epic, Meditech, Soarian, Xclaim, Epremis, etc.)
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.
At Aspirion we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, and vision insurance upon hire, matching 401k, competitive salaries and incentive programs.