Advanced Reimbursement Analyst - Healthcare Claims A/R

Guidehouse; El Segundo (CA); Hybrid; USD 38,000 - 64,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Holidays

Discretionary incentive bonus

Parental Leave

Tuition Reimbursement

Learning Opportunities

Employee Referral Program

Job summary

Guidehouse is seeking an Advanced Reimbursement Analyst to identify, document, and collect underpayments from Medicare/Medicaid under contract terms. This hybrid role supports two days in Lewisville, TX or El Segundo, CA and three days from home, with duties ranging from collections to contract term reconciliation.

The ideal candidate will have 1–3+ years in healthcare-related roles and a high school diploma (or GED) with relevant experience.

Qualifications

• High School Diploma or GED required; 3+ years of relevant experience in lieu of diploma is acceptable.
• Experience in office, business, operations, customer service or healthcare field is preferred.

Responsibilities

• Collect on identified underpayments.
• Document activity affecting accounts.
• Reconcile accounts based on contract terms.
• Collaborate with contract department on pricing issues.
• Review Medicare/Medicaid and managed care payments for contract consistency.
• Stay updated on Medicare/Medicaid payment changes.
• Maintain accurate documentation of underpayments.
• Bill payors for additional payment.
• Pursue timely and effective collections.
• Maintain departmental databases.
• Generate periodic status reports.
• Assist staff with assigned tasks.
• Maintain confidentiality of information.

Skills

Underpayments collection

Documentation

Account reconciliation

Pricing issues coordination

Education

High School Diploma / GED

3 years of relevant equivalent experience

Job description

Job Family:

Patient Account Representative

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Advanced Reimbursement Analyst will identify, document and collect managed care, Medicare/Medicaid underpayments for Contract and Reimbursement Solutions Clients. Perform any and all related job duties as assigned.

_ This position will be on a hybrid schedule working two days either in the Lewisville, TX office or El Segundo, CA office and three days from home. _

Essential Job Functions

• Collect on identified underpayments.

• Document any activity that affects account.

• Reconcile accounts based on contract terms.

• Work w/contract dept. on any pricing issues.

Duties and Responsibilities

• Review Medicare/Medicaid and managed care payments to verify consistency with payment terms of corresponding contract between client and payor.

• Keep current on Medicare/Medicaid payment changes.

• Maintain accurate, timely and thorough documentation regarding underpayments.

• Bill payors for additional payment.

• Perform timely and effective collection efforts.

• Maintain departmental databases.

• Produce periodic status reports.

• Assist departmental staff with assigned tasks.

• Maintain confidentiality of company, client and patient information.

Client Responsibility:

• Maintain confidentiality of all private health information and contract terms.

• Perform all activities within the limitations of applicable laws and regulations.

• Maximize collection of patient accounts.

• Perform all responsibilities in a professional manner and consistent with the instructions provided by the client.

What You Will Need:

• High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED.

• 1-3+ year’s experience in office, business, operations, customer service or healthcare field.

What Would Be Nice To Have:

• Experience working with Medicare/Medicaid claims as well as Commercial Payors

• Experience in healthcare billing/collections or claims processing in a hospital environment

• Experience with hospital systems such asCerner, Epic or Meditech preferred

• Persuasive negotiator.

The annual salary range for this position is $38,000.00-$64,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [e-mail]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [e-mail]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.