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.

Essential Responsibilities:

  • 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

  • Retroactive payments

  • Double billing/payments

  • Inaccurate postings

  • Change 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

  • 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.

Non-Essential Responsibilities:

  • 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

Minimum Education:

  • 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

Location: California-CA-Remote

Requisition ID: 1800110E

EEO/Minorities/Females/Protected Veterans/Disabled.