Sr. Recovery Data Analyst

Meridian Health Plan   •  

Detroit, MI

Industry: Finance & Insurance

  •  

5 - 7 years

Posted 62 days ago

This job is no longer available.

Who we are:

Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

A Day in the Life of a Sr. Recovery Data Analyst

Performs data analysis and provider profiling to determine recovery opportunities for claims that are overpaid due to retroactive member termination, inappropriate coding, duplication of payments, non-authorized services, erroneous contract or fee schedule reimbursement, non-covered benefit(s) and other reasons. Provide recommendations to reduce future occurrences of overpayments.

Responsibilities

  • Acts as team lead on large projects requiring coordination with multiple departments within and outside the company.
  • Analyzes contractual obligations and identifies/pursues overpayments on claims for various reasons.
  • Prepares detailed analyses on mis-paid claims with complex business requirements and partners with IT resources for data pulls, analysis, and validation.
  • Assists in designing and implementing relational data structures related to overpayment issue.
  • Summarizes information for business partners for review and resolution and provides recommendations on recovery strategies.
  • Monitors progress of overpayment projects and executes on next step
  • Develops comprehensive and detailed analyses on erroneous payments in order to support the revenue collection and reconciliation process.
  • Develops complex data queries to generate reports of overpaid claims
  • Mentors junior recovery analysts
  • Ownership and oversight of specific recovery processes

Qualifications

What you can bring to Meridian:

  • Bachelor's degree in related field
  • 5+ years' experience in business criteria development
  • 5+ years in claims processing, claims operations or claims recovery
  • 1+ years in data analysis
  • Strong managed health care knowledge
  • Knowledge of Medicaid Managed Care guidelines
  • A thorough understanding of the role and objectives of all MHP Departments
  • Knowledge of plan policies and procedures
  • Familiarity with healthcare laws, regulations and standards
  • Working knowledge of the National Committee for Quality Assurance (NCQA), URAC or general accreditation policies and procedures

What Meridian can offer you:

  • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
  • Opportunity to work with the industry's leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
  • Meridian offers 401k matching that is above the national average.
  • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor's or Master's degrees.
  • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.