Recovery Analyst II in Orange at Prospect Medical Systems

Date Posted: 8/15/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    8/15/2020
  • Job ID:
    16038

Job Description



Recovery Analyst II

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Communicate and disseminate, to management, guidelines or documentation relating to Recovery. Review and assess all potential avenues of recovery and make recommendations to management on which items are recoverable and within what time frame. Trend and report on recovery activities. Plan and set goals, in dynamic environment, for department goals. Develop self, and maintain knowledge of managed care industry at all times.



Job Responsibilities/Duties

  • Requires experience and extensive knowledge in each of the following areas: Claims processing and HMO contracts.
  • Compile and organize claims data for forecasting and trending purposes.  Interprets key data and presents findings in a clear, concise manner – data to be presented in written, visual or oral fashion.
  • Develops appropriate recommendations and suggestions based on findings and collaborates with management in the development of action plans where required as it relates to recover for insured services, stop loss, and additional recoveries.
  • Creates and analyzes monthly, quarterly, and annual claims data reporting for internal management review.  Develops, analyzes and monitors new, routine and ad hoc reports.
  • Collaborates with management team in analysis, requiring expertise in procedure codes and claims, identifying problem areas.  Develops analysis to identify cause of problem and facilitate a resolution.  Provides advice and consultation on types of analysis to perform to identify problems.
  • Actively participate in supporting internal departments with analysis and reports.
  • Other duties as assigned.


Qualifications

Minimum Education:  Bachelor’s degree or equivalent education and experience in business administration, finance or related field preferred.

Minimum Experience:  Experience with claims processing and/or coding in an HMO managed services organization required.  Two to 4 years of claims and financial analysis experience in the health care environment.  3+ years experience in collecting, analyzing, and presenting data and recommendations to management required.

Req. Certification/Licensure:  None



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit  https://prospectmedicalsystems.com/about-us/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm



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