Sr. Healthcare Reclamation Analyst

Accountabilities:

• Review internal data and payer correspondence to determine the correct order of benefits and resolve Coordination of Benefits and Third Party Liability issues.
• Investigate complex eligibility discrepancies, claims issues, payment discrepancies, and other records requiring detailed research.
• Communicate with healthcare insurance carriers to determine primacy, resolve questions, and facilitate appropriate payment or account action.
• Analyze and interpret 277 claim rejections, Explanation of Benefits, and other payer communications.
• Research eligibility scenarios, claims appeals, and other issues to achieve successful resolution and payment.
• Take appropriate action based on payer requirements and maintain clear, accurate documentation in internal systems.
• Update account records with payer contacts, demographic information, communication notes, outreach attempts, and account status.
• Work assigned inventories efficiently while consistently meeting or exceeding established productivity and quality targets.
• Collaborate with internal teams to identify opportunities for improving claims billing, denial management, workflows, and systems.
• Contribute to the development of scripts, guidelines, training materials, and other tools supporting professional communication with healthcare carriers and providers.
• Support management with inventory assessment and distribution across team members.
• Provide feedback to management and analytics teams to improve products, services, workflows, and documentation.
• Assist with new client program launches, client requests, reporting, reconciliations, testing, data analysis, and analytics reviews.
• Lead or contribute to ad hoc projects, operational initiatives, and the establishment of best practices.
• Apply policies, procedures, training, HIPAA requirements, client requirements, and applicable regulations consistently.
• Support junior team members through knowledge sharing, instructional guidance, and subject matter expertise.

Requirements:

• High school diploma or GED required; college education preferred, or an equivalent combination of education and relevant experience.
• At least 4 years of progressively relevant experience in billing reclamation, healthcare recovery, denial management, Coordination of Benefits, Third Party Liability, or related functions.
• At least 1 year of experience contributing to operational initiatives involving workflow improvement, reporting and data analysis, new client or program setup, subject matter expertise, training, or staff oversight.
• Strong knowledge of healthcare operations, medical terminology, and medical coding.
• Substantial expertise in Coordination of Benefits, Third Party Liability, accounts receivable, and healthcare reclamation.
• Proven ability to interpret 277 rejections and Explanation of Benefits and use that information to resolve both standard and complex payment issues.
• Strong investigative, critical-thinking, analytical, and problem-solving abilities with a high degree of accuracy.
• Excellent professional communication skills and the ability to build positive relationships with healthcare carriers, clients, providers, and internal teams.
• Ability to handle sensitive information appropriately and consistently follow HIPAA standards and applicable regulations.
• Intermediate to advanced Microsoft Excel skills, including the ability to analyze large datasets.
• Strong proficiency with computers, standard office applications, online tools, and communication technology.
• Ability to work independently while contributing effectively to a collaborative team environment.
• Ability to serve as a subject matter expert, lead by example, and support the development of junior team members.
• Strong organizational skills, attention to detail, adaptability, and ability to manage multiple priorities in a fast-paced environment.
• Ability to quickly adjust to changing assignments, processes, programs, and business requirements.
• Ability to obtain and maintain required client clearances and successfully complete applicable background and screening requirements.
• Ability to work legally in the United States.

Benefits:

• $52,000–$58,000 annual salary, depending on experience, skills, certifications, and other relevant factors.
• Fully remote work from anywhere in the United States.
• Medical, dental, and vision insurance.
• Flexible Spending Account and Health Savings Account options.
• Tuition reimbursement.
• 401(k) with company matching.
• Additional health and wellness benefits and perks.
• Flexible and trusting work environment that supports employee autonomy.
• Opportunities to contribute to operational improvements and new client programs.
• Professional development and opportunities to apply healthcare reclamation expertise at a senior level.