Payor Analyst

Description

Summary/Objective
This position is responsible for completing complex appeals and payor projects as well as working with the billing vendor to ensure claims are being processed accurately.

Essential Functions

• Monitors the rejected and denied claims to determine the root cause and work to resolve and prevent future errors. 
• Maintains appropriate documentation and files regarding all patient account interactions, assuring timely documentation is noted in the Revenue Cycle Management System.    

Representative / patient name talked to

• Date and time of conversation and reference number if applicable. 
• Telephone number of insurance company or patient
• Detail of insurance benefits or pertinent documentation
• Follow-up dates and detail if applicable
• Field questions from other co-workers and staff as required. 
• Actively participates in facility and departmental communication through daily review of email messages. 
• Develop, maintain, and provide workflows and trainings for the billing vendors to ensure claims are being appeal or reprocessed correctly.
• Other duties as assigned by supervisor. 

Competencies

• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external patients/staff. 
• Requires well developed organizational skills and basic office operations to assure appropriate documentation and follow-through to meet the patient and department needs.
• Can evaluate a variety of patient situations and make timely and decisive decisions, with minimal supervision. This includes analyzing claim data to determine the next best step in the claim filing process.
• Demonstrates proficient computer skills including accurate data entry into Microsoft Office software (Outlook, Work, Excel). Along with basic proficiency of internet usage. 
• Knowledge and/or willingness to understand insurance guidelines and requirements. 
• Have a current knowledge of CPT/ICD10/HCPCS usage. 
• The ability to review documentation to obtain basic procedural and/or diagnosis codes.  

Supervisory Responsibility

None

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Position Type/Expected Hours of Work
Full Time / Monday – Friday

Travel

None

Work Authorization/Security Clearance 

Must be authorized to work in the US for any employer

AAP/EEO Statement 

US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Requirements

High School Diploma or GED equivalent

Coding certification through AAPC preferred.

2+ years’ experience in medical billing and/or AR follow up