Health Management Systems, Inc. Provider Services Analyst - Los Angeles Area in CA, California
HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Provider Services Analyst - Commercial who conducts on-site account analysis for identifying and recovering client overpayments made to healthcare providers. 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 delivering successful field performance within assigned territory.
Conducts on-site account analysis on behalf of HMS clients; analyzes the following situations to identify instances of overpayments and clarifies discrepancies:
Payment received by more than one payor
Change written off in excess of amounts actually billed
Debit contractual adjustments
Reclassification of accounts
Provider A/R collection systems modeling net revenue at the time of billing
Incorrect coordination of benefits
Identification of refund trends that can be applied across contract base to maximize revenue
Collaborate with upper management and Client Services on payer trending
and act as a liaison between the Provider and HMS.
Delivers summary reports to Providers on results of project work and their corresponding revenue implications.
Interpret and apply contract language through claim adjudication process.
Consults with Providers troubleshooting Client issues
Ensures all processes meet HIPAA and Government security requirements with regards to sharing/storage of PHI (Personal Health Information).
Establishes effective working relationship with both Provider and internal staff.
May assist with training and mentoring new and current auditors.
Meets or exceeds established production and revenue goals set forth by management.
- Performs other functions as assigned
Knowledge, Skills and Abilities:
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 individual environments.
Ability to organize well.
Ability to be versatile and easily adaptable to new regulations and rules from client to client.
Ability to diverse in different standards across the nation per client needs.
Ability to be careful and thorough about detail.
Ability to adhere to corporate policies and guidelines concerning audit protocol and adherence to HIPAA guidelines
Ability to maintain and enhance existing customer relationships
Demonstrated understanding of coordination of benefit rules
Familiar with secondary billing, appeals, and contractual adjustments
Understanding of healthcare claim billing and collection terminology
Healthcare reimbursement or claim knowledge
Work Conditions and Physical Demands:
Involves significant travel as well as sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 50% of time based on business needs; at times on short notice
High School Diploma or GED required
Bachelor’s or Associates degree preferred
Minimum Related Work Experience:
- 1 years of healthcare billing experience, audit or collection and accounts receivable experience in a healthcare environment preferred, but not required
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Title: Provider Services Analyst - Los Angeles Area
Requisition ID: 1800110E