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Performant Healthcare, Inc. · 1 month ago

Senior Healthcare Coordination of Benefits (COB) Analyst

United States

Full-time

Remote

Mid, Senior Level

$48K/yr - $64K/yr

4+ years exp

Performant Healthcare, Inc. is a leading healthcare intelligence company that provides value and efficiency to health plans. The Senior Healthcare Coordination of Benefits (COB) Analyst is responsible for reviewing and analyzing client records, resolving discrepancies with insurance carriers, and maximizing revenue for recovery programs, while also supporting team development and operational improvements.

AnalyticsCustomer ServiceFinancial Services

Responsibilities

Leverage strong knowledge and expertise in COB/TPL/EOB to gather and review eligibility, investigate policy coverage to determine proper order of benefits and resolve primacy issues that will bring successful payment or other appropriate account action

Ability to identify unique trends from payer data in order to isolate policy details to process appropriately per client and business needs

Successfully solve complex data or record discrepancies and/or issues

Communicate effectively with carriers, employers, and/or providers to determine primacy; answer complex questions and/or provide information that will bring to successful payment or other appropriate account action

Contact Healthcare Insurance carriers regarding claim responses

Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions

Analyze and understand written communication from insurance companies including explanation of benefits (EOBs)

Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems

Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers

Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group

Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) and consistently resolve the most complex eligibility discrepancies and questions

Initiate applicable action and documentation based upon insurance carriers selected

Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable

Supports management with inventory assessment and distribution to team members

Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation

Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business

Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example

Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management

Supports team training activities and contributes to development and enhancement of training materials and tools

Leads and contributes to ad-hoc projects and initiatives and establishing best practices

Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making

Follows and complies with company, departmental and client program policies, processes, and procedures

Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations

Successfully completes, retains, applies, and adheres to content in required training as assigned

Consistently achieves or exceeds established metrics and goals assigned, including but not limited to, production, quality, and completion of assigned projects with high quality and timely results

Completes required processes to obtain client required clearances as well as company required background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note client/government clearance requirements are not determined or decisioned by Performant.)

Demonstrates Performant core values in performance of job duties and all interactions

Corrects areas of deficiency and oversight received from quality reviews and/or management

Performs other duties as assigned

Qualification

Healthcare billingCoordination of BenefitsExplanation of BenefitsMedicaid experienceData analysisInvestigative skillsMicrosoft ExcelCritical thinkingInterpersonal skillsCommunication skills

Required

High School diploma or GED

Minimum 4 years of directly related progressive experience (claims, billing, eligibility, Medicaid, EOB, etc.), including Coordination of Benefits and Third Party Liability, demonstrating depth and breadth of knowledge and capability required for the position

Minimum 1 year of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, contributing to the set-up of new clients or programs, or subject matter expertise applied to department workflows or projects, direct or indirect staff oversight or training, etc

Demonstrated experience gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving