BASF

Senior Data Mining Analyst, Healthcare Coordination of Benefits, COB

BASF

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $62,000 - $76,000 per year

Job Level

Senior

About the role

  • Conducts COB investigations and associated claims reviews to determine proper payment according to COB rules, commercial billing guidelines, contracts, CMS regulations, and applicable laws/policies.
  • Documents findings within audit tracking system and maintains thorough objective documentation.
  • Provides support to client business processes related to claim recovery and supports appeals as needed.
  • Investigates, researches, and analyzes claims data, applying medical or pharmacy policy to determine order of benefits with other payers.
  • Creates narrative rationale corresponding with audit determinations and meets assigned revenue and metric goals.
  • Serves as a senior claims payment resource, providing expertise and guidance and may support training other analysts.
  • Works collaboratively to identify vulnerabilities, monitors and reports on work, and contributes to process improvements and quality assurance.
  • Complies with company policies, completes required training, and demonstrates Performant core values.

Requirements

  • Bachelor’s degree or an equivalent level of competence obtained through experience, education and/or training.
  • 8+ years of experience in the health care industry in eligibility or claims analyst type of function.
  • 5+ years of experience with clearing houses/claims processing systems (e.g. UNET, COSMOS, NDB, TOPS, FACETS, AMYSIS, MHS, etc.).
  • 5+ years working with large volumes of membership or eligibility data.
  • Previous COB claims recovery experience required.
  • Experience with CMS shared data files and CAQH files preferred.
  • Employment VISA Sponsorship is not available for this position.
  • Must submit to, and pass, a pre-hire criminal background check and drug test.
  • Ability to obtain and maintain client required clearances and pass regular background/drug screenings post-hire as required.
  • Must not appear on any state/federal debarment or exclusion lists.
  • Access to reliable, secure high-speed Internet at home office if working remote.
  • Intermediate to advanced proficiency with Microsoft Excel, Word, and Access.
  • Typing skills and working knowledge of computer functions and applications such as MS Office (Outlook, Word, Excel).