Trend Health Partners

Claims Specialist

• Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures.
• Assist client in identifying, validating, and recovering claim overpayments.
• Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s)
• Review and resolve disputed overpayments from client/provider.
• Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts.

Claims Analyst I

Analyst

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Credit Balance Analyst I

Project Manager

• Support payer-facing revenue integrity projects from initiation through delivery.
• Accurate invoicing support.
• Receivables processing and payer inventory workflows.
• Client reporting and special projects involving invoicing or payment workflows.
• Identify opportunities for process improvements.

Project Analyst

• Collaborate with internal and external partners to improve data quality
• Streamline new concept development and continuously improve outcomes
• Optimize workflows and reduce costs
• Translate business needs into meaningful analysis
• Provide a unique blend of healthcare business knowledge with data, technical, and analytical expertise
• Understand healthcare data, perform data analysis, and ensure implementation meets client and business requirements
• Function as a consultant to help translate business information needs into deliverable requirements and specifications

Senior Performance Analyst

Auditor

• Review medical records, clinical documentation, and claims to ensure accurate ICD-10, CPT, and HCPCs coding
• Apply coding principles based on industry standards and company/client needs
• Validate CPT, HCPCs and ICD-10 coding accuracy of outpatient claims
• Apply MUE/NCCI
• Review medical documentation to support billed services/items
• Provide appeal responses for claims utilizing industry standards and company/client policies
• Assist with new concept development
• Assist with claim selection criteria
• Maintain certifications and continuing education requirements
• May require client communication to support findings

Coding Auditor – Outpatient

• Determine denials from remittance /explanation of benefits
• Trend root cause and take appropriate steps for resolution by crafting detailed appeal letters
• Contact insurance payers for resolution
• Ensure legal compliance by following guidelines, account contract, and the company's business plan
• Maintain quality service by following corporate customer service practices and protocols
• Analyze claims to determine the validity of recovery options
• Draft detailed & convincing correspondence to effectuate reimbursement
• Contact insurance carriers, patients, attorneys, and employers to facilitate reimbursement
• Interpret contracts as it relates to reimbursement, timelines, and verbiage of payer responsibilities guidelines to be followed
• Use of payer portals and other technologies to advance time to revenue
• Identify defined root causes and trends from client inventories to formulate recovery resolutions or next steps in best practices
• Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

Claims Analyst I

Credit Balance Analyst I

Project Analyst

Senior Performance Analyst

Coding Auditor – Outpatient

Provider Services Analyst I