Medical Insurance Payer Specialist

Company OverviewThis position performs complete health insurance payer analysis with respect to medical billing and reimbursement functions and is responsible for all aspects of payer research, communicate and manage complex payer and industry changes that impact Client’s revenue cycle for Remote Patient monitoring, Chronic care management and Medical Nutrition Therapy services and its operations or strategies.Job SummaryResponsibilities and DutiesPerform health insurance payer analysis respect to medical billing and reimbursement functionsExplore and update key healthcare industry payers trends at both macro and micro levelsDefine payer policies, coverages, pay rates for proceduresUpdate internal and external stakeholders with policy changes in a timely mannerAnnually updates insurance payment rates for each CPT/HCPCS codeExecute on the implementation of assigned projects or operational issue resolutionMeet tight deadlines in a time sensitive and resource constrained project environmentBuild payer coverage dashboard with payer benefits and PFS rateAdvancing payer relationships by keeping up to date with payer policy changesFollow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO/PPO, etc.Engage in end-to-end revenue cycle management process, including Eligibility verification, Authorization, charge entry, claim submission (including 837's and 1500 forms), payment posting, and accounts receivable management and extract reports from billing softwareUnderstanding the EOB & ERAEngage in follow-ups with insurance companies and medical groups to address denials and payer coverage issuesDevelop, implement, and execute departmental procedures and processesGenerate reimbursements and analyze the revenue data to report trends related to errors & denialsStrong data mining skill to identify trends, areas for improvement, and opportunities for revenue growthAnalyze and identify opportunities to optimize revenue capture and reduce revenue leakageEnsure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to ensure accurate and compliant billing practicesConduct detailed data audits and clean-up as scheduled and as neededConduct payer coverage training for internal stakeholders and maintain adequate documentation of meetingImplement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience for customersCollaborate with IT teams to implement technology enhancements that improve billing & revenue efficiencyMaintain organized documentation of all billing and invoicing activitiesSending out invoices and maintaining a tracking system of incoming and late paymentsCollaborates with internal teams, supporting the efforts and needs of other departments by providing assistance in a team-oriented approachMaintain compliance with HIPAA(Health Insurance Portability and Accountability Act of 1996)Must be a gatekeeper of the payer research and knowledge gainedPerform other related duties as required or requestedQualifications and SkillsBachelor's degree in accounting, health care administration, finance, business, or related field, with 5+ years of experience in an office environment or healthcare-related fieldKnowledge of CPT/ICD-10/HCPCS codes and EHR systemsProficient in medical terminology and insurance plansExperience with process improvement, quality control, data analysis and/or reportingIntegrity and respect for confidentiality and privacyAttention to detail and the ability to work with a variety of databasesLeadership skills, including presenting and representing Payer Knowledge both internally and externallyDemonstrates the ability to work independently, is self-motivated, and self-directed with excellent verbal and written communication and documentation skillsDemonstrates strong organizational and time management skills, enabling effective prioritization of workflow to meet client requirements. Possesses excellent customer service skills to ensure client satisfaction.Ability to analyze problems and devise strategic solutionsStrong computer literacy with using Google Docs, Sheets, Slides and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)

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