Payer Compliance & Revenue Integrity Analyst

U.S. Anesthesia Partners; United States; Remote; USD 23,000 - 36,000; Full time

Job summary

US Anesthesia Partners seeks a Payer Compliance Specialist I – RCM to analyze allowed amounts on claims and determine contract compliance. You will review postings, file appeals, and coordinate corrections to maximize allowances per contract.

You will identify and resolve payer issues affecting receivables, communicating with internal RCM teams and insurers. A quarterly bonus is possible based on performance.

Qualifications

• High school graduate or equivalent required.
• Minimum of 2 years experience in healthcare revenue cycle.
• Analytical abilities to identify and resolve underpayments relating to payers, coding issues, etc.
• Familiarity with basic medical terminology preferred.
• Knowledge of CPT, ICD-9, and ASA coding preferred.

Responsibilities

• Follows payer compliance management standard operating procedures.
• Analyzes, evaluates, and validates payer under and over-allowable variances in work queues.
• Manages corrective actions to resolve variances via appeal, cross-workflow, or escalation to management.
• Gathers appeal documentation and files appeals to payers as appropriate.
• Follows up on appeal results 45–60 days post submission.
• Reports payer systemic issues creating variance trends to leadership.
• Uses out-of-model guidance matrix to report over-allowed variances to leadership and finance.
• Familiarizes payer policies and contractual terms for assigned payer.
• Researches refund requests and responds appropriately.
• Queries leadership on potential contract term discrepancies.
• Communicates regularly with management about payer variance issues.

Skills

Healthcare revenue cycle

Analytical skills

Teamwork

Verbal communication

Written communication

Independent working

Medical terminology

CPT coding

ICD-9 coding

ASA coding

Education

High school diploma or equivalent

Tools

Excel

Word

Job description

US Anesthesia Partners seeks a Payer Compliance Specialist I – RCM to analyze allowed amounts on claims and determine contract compliance. You will review postings, file appeals, and coordinate corrections to maximize allowances per contract.

You will identify and resolve payer issues affecting receivables, communicating with internal RCM teams and insurers. A quarterly bonus is possible based on performance.