Healthcare Collections Analyst

Overview

Processes medical insurance claim overpayments identified through data mining, including posting recoveries, processing adjustments and offsets, and conducting collection activities to secure refund checks.

What you'll do

• Process overpayments by posting provider refunds, adjustments and offsets, and prepare notification letters.
• Conduct outbound calls to healthcare providers to request payment recovery in a professional, courteous and respectful manner.
• Clearly communicate payment requests, claim details and supporting information to provider offices.
• Collaborate with internal teams to resolve discrepancies or provider questions efficiently.
• Review claims for missing or incomplete information, calculate payment, or validate identified overpayments.
• Validate overpayments based on policy instructions and claim coding details, and maintain a library of validation instructions, client-specific rules and system processing instructions.
• Review and manage outstanding accounts receivable with guidance from the operations leader, contact providers to collect payment, and identify issues with unpaid accounts.
• Perform support and administration tasks including data entry, tracking correspondence, and generating, stuffing and mailing letters.
• Understand client-specific policies related to claim payments, provider manuals and member benefits.
• Maintain legal compliance with company policies, client policies, procedures, guidelines, and state and federal regulations.
• Recognize and report system issues and prepare basic internal and external reports by collecting, analyzing and summarizing information.
• Maintain department productivity goals and standards with a focus on accuracy and quality, and complete special projects as assigned.
• May assist in the identification process and audit concept improvements.

What you'll need

• Minimum of one (1) year experience in administration support or data entry.
• High school diploma.
• Applicants must already be legally authorized to work in the U.S.

Nice to have

• One (1) year experience in a healthcare claims operations environment.
• College degree in a role-related field.
• Excellent verbal and written communication skills.
• Strong MS Office skills (Word, Excel, PowerPoint).
• Strong organization and time management.
• Ability to work in a fast-paced environment with flexibility to handle multiple priorities.

Details

• Remote, US.
• Full-time position.
• Works under direct supervision, handling basic problems independently and collaborating with a senior team member on more complex issues.
• Visa sponsorship and other immigration support are not available.