Sr. Healthcare Reclamation Analyst

Machinify; United States; Remote; USD 52,000 - 58,000; Full time

Benefits offered by this job

Work from anywhere in US

Health and wellness benefits

Flexible work environment

Job summary

Machinify is seeking a Sr. Healthcare Reclamation Analyst to review large client data and payer correspondence, determine eligibility and primacy, and recover funds for clients who paid in error. The role emphasizes analyzing 277 rejections, EOBs, and payer feedback to optimize outcomes.

You will work with internal teams, develop new client programs, and continuously improve operational processes while ensuring HIPAA compliance and high quality results.

Qualifications

• High School diploma or GED; college preferred or equivalent experience.
• Minimum 4 years of directly related progressive experience (billing reclamation, recovery, denial management, etc.).
• Minimum 1 year of experience leading or contributing to operations workflow, data reporting, or client programs setup.
• Experience gathering, researching, interpreting, and documenting data and requirements for projects.

Responsibilities

• Leverage COB/TPL/Recovery knowledge to determine proper order of benefits and resolve primacy issues.
• Solve complex data or record discrepancies and issues.
• Communicate with carriers to determine primacy and facilitate payment or other actions.
• Contact healthcare insurers regarding claim responses.
• Analyze and interpret EOBs and other claims communications.
• Collaborate with internal teams to improve workflows and systems.
• Contribute to development of scripts, guidelines, and tools for client programs.
• Maintain productivity metrics and support broader team goals.
• Research scenarios to resolve eligibility discrepancies and payment issues.
• Update systems with accurate contact and demographic information.
• Support inventory distribution and management for the team.
• Provide feedback to improve products, workflows, and documentation.
• Assist management on projects, reporting, data analysis, and testing.
• Lead ad-hoc projects and establish best practices.
• Maintain attendance and professionalism.
• Follow policies and ensure HIPAA compliance.
• Complete required trainings and achieve performance metrics.
• Pass required background and drug screenings as needed.

Skills

Healthcare knowledge

Medical terminology

Medical coding

Coordination of Benefits

Third Party Liability

277 Rejections / EOBs

Data analysis

Excel

Communication with carriers

Education

High School diploma or GED; college preferred

Tools

Excel

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

At Machinify, we’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. The Sr. Healthcare Reclamation Analyst reviews and analyzes large volumes of client data and payer correspondence, investigates coverage to determine eligibility and primacy, and gathers and interprets 277 rejections and explanations of benefits as well as payer feedback to recover funds for clients who have paid in error. Additionally, the senior role leverages subject matter expertise and experience to perform a variety of analysis and trending, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs.

What You’ll Do:

• Leverage knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.
• Successfully solve complex data or record discrepancies and/or issues.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Actively collaborate with internal groups and/or functions with 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.
• 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.

What You Bring:

Required and Preferred Qualifications

• High School diploma or GED; college preferred: equivalent combination of education and related experience.
• Minimum 4 years of directly related progressive experience (billing reclamation, recovery, denial management, etc.), including Coordination of Benefits, Third Party Liability, and/or Reclamation, 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.

What experience you bring (Role Requirements)

• Strong knowledge and substantial experience with healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovering and/or researching the same.
• Demonstrated expertise and experience with Coordination of Benefits, Third Party Liability and Accounts Receivable specifically relevant to the line of business.
• Proven strength gathering and interpreting 277 rejections or Explanation of Benefits to answer questions and resolve claim issues.
• High degree of critical thinking and analytical accuracy required
• Ability to communicate professionally and effectively with carriers and other audiences regarding claims and Coordination of Benefits (COB).
• Strong investigative skills, with proven ability to gather and interpret 277 Rejections and Explanation of Benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.
• Protect patients’ privacy, understands and adheres to HIPAA standards and regulations.
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude; develops positive rapport with clients.
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
• Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
• Intermediate to advanced Microsoft Excel skills with demonstrated skills analyzing large data sets relevant to the position.
• Applies knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.) and can provide instructional support to others.
• Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members.
• Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment; effectively serve as subject matter expert, lead by example, and a lead contributor to the team overall results and progress.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change.
• Ability to obtain and maintain client required clearances as well as pass company required background and/or drug screening.

What We Offer:

• Work from anywhere in the US! Machinify is digital-first.

Additional health and wellness benefits and perks

• Flexible and trusting environment where you’ll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.

Pay range: $52,000 - $58,000

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at:https://www.machinify.com/candidate-privacy-notice/