Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Sr. Financial Recovery & COB Analyst (remote)
Summary of Job
Continuously and proactively assess and monitor vendor operations performance to ensure contractual targets and quality expectations are met. Responsible for daily monitoring and support of all financial recovery efforts to ensure claims in a negative balance and/or overpayment identifications are recovered timely and appropriately. Work directly with special handling, Tier 1 and high exposure non special handling facilities across the enterprise. Identify areas of improvements and work with internal and external business partners to provide appropriate action plans for resolution and prevention of future claim overpayments.
Responsibilities:
- Enhance recovery of claims by fostering partnerships with CCI/Emblem Providers and Provider Network Management related to overpayment and collection activity via direct provider contact.
- Ensure timely response from providers on overpayments.
- Investigate and analyze claim overpayments and discuss overpayment root cause with providers to ensure rapid closure of outstanding overpayment balances.
- Responsible for recoupment and reconciliation of negative balance opportunities.
- Conduct research and analysis of refund root cause and initiate corrective action plans for future prevention and issue resolution.
- Collaborate and work cross-functionally with other operational areas (Claims, Provider Network Management, Contract Configuration, Provider File Operations, Payment Integrity, etc.) to ensure causes of overpayments are understood and root causes are ultimately remediated.
- Collaborate with the Cognizant vendor and IT to ensure full advantage of system offset capabilities is taken to expedite recovery of overpayments.
- Analyze overpayment data to identify opportunities for improvement in financial recovery processes and reduction of overpayment root causes.
- Thoroughly investigate all possible third-party liability cases (Commercial/Medicare Insurance, Workers Comp, Motor Vehicle Insurance) that are referred by Claims Staff, Billing and Enrollment, Member Services, Provider Services, Reports or Mass Mailing Questionnaires.
- Monitor vendor COB transactional quality and deliverables.
- Analyze data to identify additional COB opportunities.
- Assess and monitor performance of vendors for each core process to meet contractual requirements and align with EmblemHealth/CCI customer experience objectives. Includes SLA performance review analysis.
- Conduct reviews, transactional audits, and compliance and operational procedure reviews.
- Make suggestions for process improvements and focused reviews to enhance vendor quality.
Qualifications:
- Bachelors Degree
- 3 – 5+ years of relevant experience in auditing and assessment activities, preferably in a healthcare provider environment (Required)
- Additional experience/specialized training may be considered in lieu of educational requirement (Required)
- Ability to independently perform research utilizing multiple sources (Required)
- Ability to discern and identify patterns/trends of issues and provide recommendations for resolution (Required)
- Facets system experience (Preferred)
- Excellent collaboration skills and the ability to influence management decisions (Required)
- Excellent communication skills (verbal, written, interpersonal) (Required)
- Strong auditing skills that be applied across all types of business problems (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.