Conditional Payment Analyst (28951)

Description

SUMMARY

The Conditional Payment Analyst is responsible to evaluate Medicare conditional payment letters and work with clients and Medicare to effectuate a successful dispute or appeal. This position is responsible to ensure all services are completed with the highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates. The Conditional Payment Analyst is also responsible to maintain communication with the sales team to ensure proper communication with the client.

Minimum Required Qualifications

Education and/or Experience

Associate’s Degree or equivalent required. Experience in the insurance industry preferred.

Certificates, Licenses, Registrations

No specific requirements.

Essential Job Functions

• Evaluate Medicare conditional payment letters, notices and demands to determine the appropriate course of action and provide claims-appropriate recommendations to clients.
• Work with internal sales team and client / claims handler to obtain all necessary information in order to successfully perform appeal or dispute.
• Respond to internal and external emails and phone calls in a timely manner.
• Triage conditional payment correspondence upon receipt.
• Create clear, concise and articulate disputes and / or appeals on behalf of company’s clients.
• Ensure appropriate documentation of all system notes and e-mails.
• Work with Team Manager to ensure client correspondence is logical and up to date.
• Assist with addressing issues and solving problems as needed.
• Assist other team members as needed and directed by management.
• Regularly communicate with management and provide support as needed.
• Abide by all rules of the company such as safety, confidentiality and organizational directives.
• Perform quality assurance as needed.
• Perform introductory training to new employees and ongoing training to staff in the conditional payment department as needed.
• Perform other duties as assigned by management.
  
  

Qualifications

ESSENTIAL COMPETENCIES

Qualifications

• Must have Knowledge of business terminology, administration and management.
  
  

Must have knowledge of Workers Compensation claims handling and of CMS/Medicare i.e. Conditional Payments, Section 111 Reporting and Coordination of Benefits and Medical Coding.

• Must be able to adequately operate a computer, fax machine, copier, scanner, and telephone.
• Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals. Ability to compute rates and percentages.
• Ability to demonstrate strong customer service skills.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to managements’ directions accurately.
• Must have excellent skills in English usage, grammar, punctuation and style.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast paced work environment.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to work well under pressure and/or stressful conditions and be able to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
  
  

Language/Communication Skills

• Ability to read, analyze and interpret common correspondence, medical records and itemized billing statements, and legal contracts and documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from customers, regulatory agencies, upper management, and/or members of the business community.
• Ability to effectively present information one-on-one, in small groups, and/or to clients or vendors of the company.
  
  

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This Position Generally Consists Of

• Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.
• Ability to operate a computer up to 4 hours at a time.
• Ability to travel to different floors of the office or other locations.
• Ability to move throughout the office.
• Occasionally lifting and/or carrying up to 10 lbs.
• Occasionally pushing/pulling up to 10 lbs.
• Occasionally subject to bending, squatting or twisting.
  
  

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Extended hours are occasionally required beyond the regular eight (8) hour work day.
• The noise level in the work environment is usually moderate.