TREND Health Partners is seeking a qualified Provider Services Analyst for our Provider Services team!

The Provider Services Analyst’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.

This is a great opportunity to join a dynamic, employee-owned company that promotes a collaborative and innovative work environment. We offer a comprehensive compensation package which includes competitive salaries, highly valued health insurance, 401(k) with employer match, paid parental leave, and much more.

Applicants must be legally authorized to work in the United States on a full-time basis as TREND Health Partners is unable to provide sponsorship for visas. Additionally, TREND’s information security controls require that all workforce members reside within the United States.

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-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 in a fast-paced environment
• Superior verbal, written, customer service, and analytical skills with resolution is preferable.
• A continuous drive to stay abreast of healthcare industry policies and regulations
• Understanding of medical terminology used in administrative and clinical documentation is preferable
• Familiarity with Microsoft Office products
• Possession of a High School Diploma with some college
• 2-5 years of experience within the healthcare market
• 2-5 years experience in navigating EMR and Patient Financial related software support systems, EPIC and Cerner experience a plus
• Previous experience within an acute care or out patient environment of revenue cycle