Provider Services Analyst I

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.

Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.

The Provider Services Analyst I’s primary responsibility is to determine denials from remittance /explanation of benefits, trend root cause, and take appropriate steps for resolution by crafting detailed appeal letters and contacting insurance payers for resolution. This individual must be self-motivated and be able to work independently and within a team structure. Ensures legal compliance by following guidelines, account contract, and the company's business plan.

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ROLE AND RESPONSIBILITIES
Maintains quality service by following corporate customer service practices and protocols

Analyze claims to determine the validity of recovery options

Draft detailed & convincing correspondence to effectuate reimbursement

Contacting insurance carriers, patients, attorneys, and employers to facilitate reimbursement

Contract interpretation as it relates to reimbursement, timelines, and verbiage of payer responsibilities guidelines to be followed

Use of payer portals and other technologies to advance time to revenue

Be able to identify defined root causes and trends from client inventories to formulate recovery resolutions or next steps in best practices

Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

QUALIFICATIONS
Prior experience reviewing, processing, and recovering in patient or outpatient clinical/technical post[1]service denials preferred

Multi-state Knowledge of payer requirements preferred but not required specifically in appeal guidelines and timeframes

Knowledge of UB04s and Claim Adjustment Reason Codes (CARC) and Reason Adjustment Reason

Codes (RARC) is preferred

Ability to resolve claims by composing a compelling appeal letter; guiding resolution of non-routine claims; auditing claims with decision resulting in a high overturn rate.

Prior experience navigating EMRs (Cerner, Epic, etc.) and patient financial systems

Thought leader with critical eye for detail

Strong ability to effectively multi-task