Trend Health Partners

Review and resolve healthcare credit balance accounts by analyzing root causes and partnering with providers for refunds or adjustments. Manage accounts receivable and communicate with internal teams to ensure accurate closure of client overpayments.

The Claims Analyst is responsible for identifying, analyzing, and recovering claim overpayments for commercial health insurance and state healthcare programs. This includes researching claims systems, developing overpayment concepts, and validating algorithms to ensure accuracy.

The Outpatient Coding Auditor reviews medical records and claims to ensure accurate coding and compliance with industry standards. They also provide appeal responses and assist in the development of new claim selection criteria.

The Underpayment Recovery Analyst is tasked with the timely and accurate review, identification, and resolution of underpaid hospital claims by conducting detailed analyses and preparing appeals. This role involves evaluating claim payment variances against contract terms, following up with payers, and identifying systemic issues to optimize client reimbursement.

The primary responsibility is to review medical records and claim information to validate the accuracy of DRG assignments and/or medical necessity for inpatient care, applying coding and clinical principles based on industry standards. This involves utilizing coding guidelines to perform DRG validation, evaluating diagnoses and procedures, and assessing the medical necessity of inpatient stays.