Conditional Payment Analyst (28981)

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

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.
  
  

Who We Are

ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and

reporting solutions for the marketplace.

ECS is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks Compliance Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.