PBO Project Specialist

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Inspire health. Serve with compassion. Be the difference.

Job Summary

Oversees the daily operations of Managed Care/Credentialing functions supporting the Prisma Health providers.

This is a remote position

Accountabilities

• Maintains payer issues log in order to track payer trends, denials and underpayments. Researches issues to insure proper billing and coding has occurred. Presents issues at monthly payer meetings.
• Works closely with Application Support Specialist on the development of payer rules for GE Centricity TES Application.
• Oversees weekly management of the TES edits and provides management with an up to all that are greater than seven (7) days old. Also monitors provider edits and reports to management those greater than (30) days old. Provides graph, by practice, for TES edit compliance.
• Reviews payer websites for new/revised content providing updates to UMG practices. Assists with keeping the Registration Resource current.
• Attends all payer education meetings and provides updates to practices.
• Meets with Department Managers and Revenue Cycle team to determine issues for presentation to the Managed Care.
• Attends divisional A/R meetings to address payer issues.
• Works closely with Business Management Lead to identify discrepancies in Reimbursement Schedules and actual payments.
• Performs audit on recoveries that are received via contract management system to assure amounts being reported are accurate and valid.
• Assists with reporting data regarding payer performance (payer report card) and presents findings to MSO management.
• Assists in completing double registrations, charge corrections and all other duties assigned to Practice Operations Specialists.

Supervisory/Management Responsibilities

This is a non-management job that report to a supervisor, manager, director or executive.

Minimum Requirements

Education - High school diploma or equivalent

Experience - 5 years A/R billing, collections and denials management

Required Certifications/Registrations/Licenses

n/a

In Lieu Of The Minimum Requirements Listed Above

n/a

Other Required Skills and Experience

• Alpha or Ingenix coding preferred
• Billing system experience required
• Preferred Certified Professional Coder preferred
• Basic computer skills
• Knowledge of office equipment
• Proficient computer skills (word processing, spreadsheets, database)
• Data entry
• Mathematical skills

Work Shift

Day (United States of America)

Location

Corporate

Facility

7001 Corporate

Department

70019216 PBO Internal Medicine/Psych A/R Team

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.