PROCESS ANALYST
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- Cebu City, Cebu
- Permanent
- Full-time
- Responsible for collecting overdue payments and establishing re-payment arrangements.
- Negotiates liability settlement of medical claims with third parties or healthcare providers; seeks reimbursement from healthcare providers and/or ensures payment of claims by appropriate insurance carrier.
General:
- Uses best practices and knowledge of internal or external business issues to improve products or services
- Acts as a resource for colleagues with less experience
- Requires in-depth knowledge and experience
- Decisions guided by policies, procedures and business plan
- Generally domestic scope/accountability
- May perform one or more of the following duties:
- Settles the health plan's subrogation (i.e. third party liability claim) and reimbursement interest; negotiates with the service provider, insurance attorney, insured, etc. in pursuit of recovering payments for services that should have been paid by another party
- Applies legal principles and practices of subrogation to maximize recoveries
- Analyzes and reviews paid medical claims to ensure the recovery amount is consistent with settled agreement
- Applies coordination of benefits (COB) practices to minimize overpayment by client
- Perform onsite auditing of healthcare providers' accounting records to identify and recover overpayments made by client
- Reviews and interprets employee benefit plan language or insurance contracts to ensure the plan rights are adhered to
- Ensures compliance with federal, state and local legislation regarding reporting and privacy issues
- All other duties as assigned
- In addition to the above, the Sr. Recovery Analyst will also perform one or more of the following:
- Provides analyses and recommendations on service delivery improvements, performance metrics and enhancements to productivity
- Trains and develops newly hired Recovery Analysts in assigned territory
- Provides quality assurance audit and feedback to Recovery Analysts in assigned territory
- Manages ad hoc projects requested by internal client