Eligibility Analyst

at MultiPlan in Naperville, Illinois, United States

Job Description

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.
Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!
This role will support our Medicare Secondary Payer (MSP) clients. This is aproduction based position where the employee is responsible to make a large number of outbound calls to insurance carriers, employers & members. The individual must be able to gather all of the applicable facts, note them in a concise manner, and apply the Coordination of Benefits (Rules) Rules to determine the correct Order of Benefits.Other responsibilities include, but are not limited to data entry and miscellaneous projects as needed.
JOB ROLES AND RESPONSIBILITIES:

1. Makes a high volume of outbound telephone calls, imaging documents, and completing data entry.
2. Uses tools to research telephone numbers and addresses.
3. Applies Coordination of Benefit (COB) Rules and establishing Order of Benefits.
4. Opens and works files in home application.
5. Creates and updates tracking reports.
6. Gathers claim overpayment information from healthcare providers.
7. Searches insurance claim database queries.
8. Pursues overpayments and initiate the refund of identified overpayments.
9. Collaborate, coordinate, and communicate across disciplines and departments.
10. Ensure compliance with HIPAA regulations and requirements.
11. Demonstrate Company's Core Competencies and values held within.
12. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
Keep the needs of external and internal customers as a priority when making decisions and taking action. Communicates across clients, members, and their employers. Manages own work and pays attention to details, uses creative problem solving skills to review, research, and update file content. Incumbents must deliver high quality results. Must be open to feedback,teamwork and show interest in contributing ideas to improve our processes. Decision making is limited and must fall within established guidelines or is escalated to supervisor.

The salary range for this position is $18.50 - $19.50. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.  Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled