This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Sr. Healthcare Reclamation Analyst based in United States. This senior analyst role focuses on recovering healthcare payments by investigating complex eligibility, coverage, and claims issues. You will analyze large volumes of client data, payer correspondence, 277 rejections, and explanations of benefits to identify and resolve payment discrepancies. Your expertise in Coordination of Benefits, Third Party Liability, reclamation, and accounts receivable will directly support improved financial outcomes. The role combines detailed case research with data analysis, operational improvement, client support, and subject matter expertise. You will collaborate with management, analytics, and cross-functional teams to improve workflows, documentation, reporting, and new client programs. As a senior contributor, you will also support team members, contribute to best practices, and help address complex operational challenges. This is a fully remote U. S. opportunity offering flexibility, professional development, and a collaborative environment. \n Accountabilities: - Review internal data and payer correspondence to determine the correct order of benefits and resolve Coordination of Benefits and Third Party Liability issues. - Investigate complex eligibility discrepancies, claims issues, payment discrepancies, and other records requiring detailed research. - Communicate with healthcare insurance carriers to determine primacy, resolve questions, and facilitate appropriate payment or account action. - Analyze and interpret 277 claim rejections, Explanation of Benefits, and other payer communications.
- Research eligibility scenarios, claims appeals, and other issues to achieve successful resolution and payment. - Take appropriate action based on payer requirements and maintain clear, accurate documentation in internal systems. - Update account records with payer contacts, demographic information, communication notes, outreach attempts, and account status. - Work assigned inventories efficiently while consistently meeting or exceeding established productivity and quality targets. - Collaborate with internal teams to identify opportunities for improving claims billing, denial management, workflows, and systems. - Contribute to the development of scripts, guidelines, training materials, and other tools supporting professional communication with healthcare carriers and providers. - Support management with inventory assessment and distribution across team members. - Provide feedback to management and analytics teams to improve products, services, workflows, and documentation. - Assist with new client program launches, client requests, reporting, reconciliations, testing, data analysis, and analytics reviews. - Lead or contribute to ad hoc projects, operational initiatives, and the establishment of best practices. - Apply policies, procedures, training, HIPAA requirements, client requirements, and applicable regulations consistently. - Support junior team members through knowledge sharing, instructional guidance, and subject matter expertise. Requirements: - High school diploma or GED required; college education preferred, or an equivalent combination of education and relevant experience. - At least 4 years of progressively relevant experience in billing reclamation, healthcare recovery, denial management, Coordination of Benefits, Third Party Liability, or related functions. - At least 1 year of experience contributing to operational initiatives involving workflow improvement, reporting and data analysis, new client or program setup, subject matter expertise, training, or staff oversight. - Strong knowledge of healthcare operations, medical terminology, and medical coding.
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