Provider Claim Recovery Analyst (Hybrid of Choice) Details

Provider Claim Recovery Analyst (Hybrid of Choice)

Independence Blue Cross - Philadelphia, PA

Employment Type : Full-Time

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

The Provider Claim Recovery Analyst's responsibilities include, but are not limited to:

• Collaborative interaction with department management regarding goals and objectives, special projects and general information sharing that leads to an effective and efficient operating department.
• Complete daily tasks that include financial adjustments, investigations on disputed claims overpayments, analyze provider data and complete reconciliations.
• Manage a book of business that includes claims overpayment recoveries (Provider/Subscriber).
• Responsible for identifying process improvement opportunities that can enhance quality and efficiency without sacrificing service.
• Working directly with third-party collections agencies to drive results for uncollectible Provider AR.
• Directly interact with providers and subscribers to resolve payment disputes.
• Assist in the development and preparation of departmental reporting metrics and analytics.
• Generate and distribute reporting to management, key stake holders and executive leadership.
• Create and maintain desk level procedure documents.
• Responsible for sharing information across the team and other business areas to reduce overall AR and limit financial risk.
• Document / prioritize system limitations and coordinate with Highmark (or other vendors) / BTS to identify technical solutions or automation opportunities.
• Self-sufficient in handling escalated cases with internal and external stake holders.

Qualifications:

• Bachelor’s degree in business-related field is a plus.
• 2 or more years’ experience in the healthcare or health insurance industry.
• AR management experience strongly desired.
• Understanding of basic business acumen is desired.
• Strong technical ability required to employ and manipulate systems to generate needed reporting, as well as to view team results.
• Must possess the ability to interface with internal and external customers at various levels.
• Willingness to work in a fast-paced, challenging environment.
• Demonstrates willingness to step outside normal business tasks to improve processes and reduce financial risk.
• Detail oriented and organized, with exceptional prioritization skills.
• Ability to effectively communicate with senior management, supervisors, peers and external providers.
• Proficient in Microsoft Applications.
• Understanding proven process improvement methodology and driving change management.
• Customer Focused.

Hybrid of Choice:

Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.