Sr. Healthcare Reclamation Analyst
Core
Recover healthcare payments by investigating complex eligibility, coverage, and claims issues to resolve payment discrepancies.
Role type
Senior Healthcare Reclamation Analyst
Builds
Improved financial outcomes through claims resolution and operational workflow improvements
Domain
Healthcare operations and billing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Coordination of Benefits, Third Party Liability, accounts receivable, medical terminology, medical coding, 277 rejection analysis, Explanation of Benefits interpretation, HIPAA compliance, Microsoft Excel (intermediate to advanced), data analysis, investigative research, claims appeals management
Preferred skills
Workflow improvement, reporting, new client program setup, subject matter expertise, training, staff oversight
Technologies
Microsoft Excel, online tools, communication technology
Responsibilities
Review internal data and payer correspondence to determine benefit order and resolve COB/TPL issues; Investigate complex eligibility discrepancies and claims issues; Communicate with healthcare insurance carriers to determine primacy and facilitate payments; Analyze 277 claim rejections and Explanation of Benefits; Research eligibility scenarios and claims appeals; Update account records with payer contacts and communication notes; Collaborate with internal teams to improve claims billing and denial management workflows; Support junior team members through knowledge sharing and subject matter expertise.
Seniority
Senior, hands-on IC with mentorship responsibilities