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.
• Communicating with various internal USAP RCM departments as well as insurance companies.
• Demonstrating a positive demeanor and professionalism with polished verbal and written communication skills.
• Identifying and resolving payer issues that negatively impact receivables.
• 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

• This position is eligible for a quarterly bonus.
• Bonuses are not guaranteed and are awarded based on company and individual performance.