Payer Compliance Specialist I

Role Overview

• Analyzing allowed amounts received on USAP claims, to determine appropriateness per contract
• Reviewing 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
• Identifying and resolving payer issues that negatively impact receivables
• Communicating with various internal USAP RCM departments as well as insurance companies
• Demonstrating a positive demeanor, professionalism, and polished verbal and written communication skills
• Meeting deadlines and handling potentially stressful situations and multiple tasks at the same time

Requirements

• 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

Benefits

• Eligible for a quarterly bonus