Triage Analyst – Zero Balance

This is a fully remote position, open to applicants in California.

📋 Description

• Analyze and interpret hospital contracts with insurance providers, model claims data, and pinpoint discrepancies in reimbursement along with opportunities for revenue recovery.

• Investigate and track regulations at the federal, state, and payer-specific levels concerning hospital reimbursement methodologies.

• Work alongside technical teams to establish and execute audit flags that highlight emerging trends in underpayment.

• Examine extensive and intricate healthcare claims data to identify trends in underpayment, denial, and reimbursement variances.

• Assess contract modeling outcomes and verify payment variances utilizing claim-level data.

• Ascertain the scope, recoverability, and suitability for zero-balance audit reviews.

• Detect, assess, and relay trends in underpayment and opportunities for revenue recovery.

• Collaborate with the Customer Success and Client Performance teams to direct relevant claims through the recovery pipeline.

• Deliver revenue intelligence and operational insights that bolster client performance, optimize reimbursement, and support strategic decision-making.

• Identify the root causes of underpayment and denial, categorizing denials appropriately.

• Review payer portals, client systems, provider notes, EOBs, remittance advice, and other documents to gain insight into account history and claim status.

• Liaise with insurance carriers and internal stakeholders to clarify claim statuses and assist with comprehensive appeal submissions.

• Maintain precise documentation of denial actions, findings, and escalation processes.

• Prioritize denials based on financial impact, aging, contractual obligations, and appeal deadlines.

• Route denied claims to suitable resolution pathways according to denial type, payer requirements, and documentation.

• Adapt to new technologies, software platforms, automation tools, reporting systems, and process enhancements.

• Ensure adherence to payer guidelines, regulatory requirements, organizational policies, and HIPAA.

• Operate both independently and collaboratively to meet productivity and quality objectives.

⛳️ Requirements

• A high school diploma or equivalent is required.

• Strong analytical and critical thinking abilities with a capacity to evaluate root causes of denials.

• Excellent written and verbal communication skills.

• Capability to multitask and handle competing priorities effectively.

• Proven aptitude for quickly learning and integrating new technologies, software applications, and operational processes.

• Ability to research and interpret insurance information and benefits accurately.

• Meticulous attention to detail and precision in documentation.

• Ability to work independently in a fast-paced setting.

• Consistent attendance and reliable performance.

• A Bachelor’s degree is preferred, or an equivalent combination of education and experience.

• Previous experience in healthcare revenue cycle or denial management environments.

• Familiarity with denial analytics platforms and navigation of payer portals.

• Experience in identifying the root causes of denials and applying critical thinking for accurate triage and routing.

• Knowledge of insurance carriers and payer guidelines.

• Demonstrated capability to identify trends and opportunities for process improvement.

• Experience in a productivity and quality metrics-driven environment.

• Experience with remote work in a structured environment.

• Familiarity with EMR systems such as Epic or similar platforms.

• Ability to comply with HIPAA, GLBA, FCRA, and other applicable laws and organizational policies.

• US remote-based employees must not work outside the United States without prior written approval.

🏝️ Benefits

• Fully remote position.

• Flexibility and opportunities for personal and professional growth.

• Chance to engage with innovative technology.

• Collaboration with a diverse and talented team.

• Opportunities for self-development and continuous feedback and learning.