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Job Information
US Anesthesia Partners Payer Compliance Specialist I - REMOTE in United States
Overview
POSITION SUMMARY:
The Payer Compliance Analyst I plays a key role within USAP. This position is responsible for analyzing allowed amounts received on USAP claims to determine appropriateness per contract. This individual will review electronic and manual postings associated with variances, appeal for reprocessing and/or request corrections as necessary for USAP to receive full allowance per contract. Additionally, this individual is responsible for working to identify and resolve payer issues that negatively impact receivables. He/she must have a thorough understanding and working knowledge of USAP contracts and payer reimbursement policies associated with the payer to which they are assigned. This individual has responsibility for primary identification of payer issues. The Payer Compliance Analyst I frequently communicates with various internal USAP RCM departments as well as insurance companies. Therefore, it is essential that the candidate demonstrates a positive demeanor, professionalism and has polished verbal and written communication skills. The position requires independent thinking, problem solving and strong interpersonal skills. Additionally, this position requires good analytical skills to identify trends and issues along with possible solutions. It is important for the Payer Compliance Analyst I to have the ability to meet deadlines and other requirements set forth by the Management Team. The candidate must be able to handle potentially stressful situations and multiple tasks at one time.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES(include but not limited to):
Follow the Payer Compliance Management standard operating procedures
Analyze, evaluate, and validate payer under and over allowable variances in workqueues
Take corrective actions to resolve the variances via appeal, cross-workflow, or escalation to management
Gather appeal documentation and file appeals to various payers as appropriate
Follow-up on appeal results 45-60 days post appeal submission
Partner with Leadership to research and report payer systemic issues creating variance trends
Use the out-of-model guidance matrix to assist with accurately and consistently reporting over allowed variances to Leadership and finance
Learn and familiarize payer policies and contractual terms associated with the payer to which the analyst is assigned
Research refund requests sent via correspondence cross-workflow and appropriately respond and/or take appropriate action
Inquire with Leadership and the Contract Management team on potential contract term discrepancies
Communicate regularly with the Management Team regarding payer variance issues
REPORTING TO THIS POSITION:No direct reports
Qualifications
JOB REQUIREMENTS(Knowledge, Skills and Abilities):
Skill in computer applications including MS Word, MS Excel
Basic knowledge of managed care programs and healthcare billing requirements necessary
Analytical abilities required to identify and resolve underpayments relating to specific payers, coding issues, etc.
Good mathematical skills
Skill in verbal and written communication
Skill in gathering and reporting information
Must display teamwork attitude and good inter-personal skills
Ability to work independently with limited supervision
Familiarity with basic medical terminology and concepts preferred
Knowledge of CPT, ICD-9, and ASA coding preferred
EDUCATION/TRAINING/EXPERIENCE:
High School graduate or equivalent
Minimum of two years of experience in healthcare revenue cycle
Functional knowledge of Excel and Word is required
PHYSICAL REQUIREMENTS:
Requires prolonged sitting, some bending, stooping and stretching
Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment
Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations
Requires lifting papers and boxes weighing up to 35 pounds occasionally
Requires dexterity to type at least 35 wpm
WORKING CONDITIONS(environment and safety):
Work performed in office environment
Involves frequent contact with professional staff and managed care organizations
Work may be stressful at times
Interaction with others is frequent and often disruptive
DISCLAIMER:The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.
Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.
(https://careers-usap.icims.com/jobs/13987/payer-compliance-specialist-i---rcm/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336089587)
Job ID2024-13987
FunctionRevenue Cycle Management
LocationUS-Remote
Employment StatusFull Time