Payer Compliance Specialist I - RCM

Overview

The Payer Compliance Specialist I - RCM plays a key role within USAP as it is responsible for analyzing allowed amounts received on USAP claims, to determine appropriateness per contract. This position will review electronic and manual postings associated with variances, appeal for re-processing, and/or request corrections as necessary for USAP to receive the full allowance per contract. Additionally, this position is responsible for working to identify and resolve payer issues that negatively impact receivables.

The Payer Compliance Specialist I - RCM 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. This position requires independent thinking, problem solving, and strong interpersonal and analytical skills to identify trends and issues along with possible solutions. This position requires the ability to meet deadlines and other requirements set forth by the management team, as well as handle potentially stressful situations and multiple tasks at the same time.

At this time, US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska.

The base pay estimate for this role is $16.49 - $26.39 hourly. The final offer will depend on the skills, experience, and qualifications of the selected candidate. This range is for base pay only and does not include bonuses or other compensation. This position is eligible for a quarterly bonus. Bonuses are not guaranteed and are awarded based on company and individual performance.

Job Highlights

ESSENTIAL DUTIES AND RESPONSIBILITIES : (The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation)

• Follows the payer compliance management standard operating procedures.
• Analyzes, evaluates, and validates payer under and over-allowable variances in work queues.
• Manages corrective actions to resolve the variances via appeal, cross-workflow, or escalation to management.
• Gathers appeal documentation and files the appeal to various payers as appropriate.
• Follows up on appeal results 45-60 days post appeal submission.
• Partners with leadership to research and report payer systemic issues creating variance trends.
• Uses the out-of-model guidance matrix to assist with accurately and consistently reporting over-allowed variances to leadership and finance.
• Learns and familiarizes payer policies and contractual terms associated with the payer to which the analyst is assigned.
• Researches refund requests sent via correspondence cross-workflow, appropriately responds, and/or takes action.
• Inquires with leadership and the contract management team on potential contract term discrepancies.
• Communicates regularly with the management team regarding payer variance issues.

Qualifications

KNOWLEDGE/SKILLS/ABILITIES (KSAs):

• High school graduate or equivalent required.
• Minimum of 2 years experience in healthcare revenue cycle.
• Functional knowledge of Excel and Word required.
• Basic knowledge of managed care programs and healthcare billing requirements necessary.
• Analytical abilities to identify and resolve underpayments relating to specific payers, coding issues, etc. are required.
• Good mathematical, verbal, and written communication skills.
• Experience gathering and reporting information.
• Must display a teamwork attitude and possess good interpersonal 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.

*The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Occasional Standing
• Occasional Walking
• Frequent Sitting
• Frequent hand, finger movement
• Use office equipment (in office or remote)
• Communicate verbally and in writing

US 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.