Provider Services Analyst Jobs Vacancy in Hms Holdings Los Angeles
Hms Holdings Los Angeles urgently required following position for Provider Services Analyst. Please read this job advertisement carefully before apply. There are some qualifications, experience and skills requirement that the employers require. Does your career history fit these requirements? Ensure you understand the role you are applying for and that it is suited to your skills and qualifications.
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Provider Services Analyst Jobs Vacancy in Hms Holdings Los Angeles Jobs Details:
HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Provider Services Analyst - Commercial who conducts on-site account analysis for identifying and recovering client overpayments made to healthcare providers. Responsible for developing and managing Provider relationships, working independently to identify and secure Provider refunds. Explains audit policies and procedures to the Provider; conducts exit conferences to review findings, and reschedules subsequent audits. Responsible for delivering successful field performance within assigned territory.
- Conducts on-site account analysis on behalf of HMS clients; analyzes the following situations to identify instances of overpayments and clarifies discrepancies:
- Payment received by more than one payor
- Retroactive payments
- Double billing/payments
- Inaccurate postings
- Change written off in excess of amounts actually billed
- Debit contractual adjustments
- Reclassification of accounts
- Charges removed
- Provider A/R collection systems modeling net revenue at the time of billing
- Incorrect coordination of benefits
- Identification of refund trends that can be applied across contract base to maximize revenue
- Collaborate with upper management and Client Services on payer trending
- and act as a liaison between the Provider and HMS.
- Delivers summary reports to Providers on results of project work and their corresponding revenue implications.
- Interpret and apply contract language through claim adjudication process.
- Consults with Providers troubleshooting Client issues
- Ensures all processes meet HIPAA and Government security requirements with regards to sharing/storage of PHI (Personal Health Information).
- Establishes effective working relationship with both Provider and internal staff.
- May assist with training and mentoring new and current auditors.
- Meets or exceeds established production and revenue goals set forth by management.
- Performs other functions as assigned
Knowledge, Skills and Abilities:
- Ability to view a monitor for an extended period of time.
- Ability to work with individuals and groups and understand their needs and capture requirements
- Knowledge of and ability to use Excel and Word
- Knowledge of scripting tools.
Work Conditions and Physical Demands:
- Primarily sedentary work in a general office environment
- Ability to communicate and exchange information
- Ability to comprehend and interpret documents and data
- Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
- Requires manual dexterity to use computer, telephone and peripherals
- May be required to work extended hours for special business needs
- May be required to travel at least 10% of time based on business needs
- Undergraduate degree or equivalent work experience
Minimum Related Work Experience:
- 1+ years related work experience
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Job Type: Full-time
- Los Angeles, CA (Required)