Payer Compliance Specialist I
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Job Description
Payer compliance specialist analyzing healthcare claim variances for US Anesthesia Partners. Appealing underpayments and resolving payer issues across revenue cycle operations.
Responsibilities:
- Follow payer compliance management standard operating procedures
- Analyze, evaluate, and validate payer under- and over-allowable variances in work queues
- Manage corrective actions through appeals, cross-workflow, or management escalation
- Gather appeal documentation and file appeals to appropriate payers
- Follow up on appeal results 45–60 days after submission
- Partner with leadership to research and report systemic payer issues creating variance trends
- Use the out-of-model guidance matrix to report over-allowed variances accurately and consistently to leadership and finance
- Learn and apply payer policies and contractual terms
- Research refund requests, respond appropriately, and take necessary action
- Inquire with leadership and contract management about potential contract-term discrepancies
- Communicate regularly with management regarding payer variance issues
Requirements:
- High school graduate or equivalent required
- Minimum of 2 years of experience in healthcare revenue cycle
- Functional knowledge of Excel and Word required
- Basic knowledge of managed care programs and healthcare billing requirements
- Ability to identify and resolve payer underpayments related to specific payers and coding issues
- Good mathematical, verbal, and written communication skills
- Experience gathering and reporting information
- Teamwork attitude and 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
- Ability to meet deadlines, handle multiple tasks, and manage potentially stressful situations
- Ability to perform the physical requirements, with or without reasonable accommodation
- US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska
Benefits:
- Quarterly bonus eligibility
- Equal employment opportunities
- Reasonable accommodations for individuals with disabilities
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