Payer Compliance Specialist I - RCM (Bonus Eligible)

US Anesthesia Partners, Inc.; United States; Remote; USD 23,000 - 36,000; Full time

Benefits offered by this job

Quarterly bonus

Job summary

US Anesthesia Partners, Inc. is seeking a Payer Compliance Specialist I – RCM to analyze allowed amounts, determine contract compliance, and process variances.

The role involves reviewing electronic and manual postings, appealing for re-processing, and resolving payer issues to maximize receivables. Candidates must have strong Excel/Word skills, healthcare revenue cycle experience, and the ability to work independently under deadlines.

Qualifications

• 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.

Responsibilities

• Follows the payer compliance management standard operating procedures.
• Analyzes, evaluates, and validates payer under and over-allowable variances in work queues.
• Manages corrective actions to resolve the variances via appeal, cross-workflow, or escalation to management.
• Gathers appeal documentation and files the appeal to various payers as appropriate.
• Follows up on appeal results 45-60 days post appeal submission.
• Partners with leadership to research and report payer systemic issues creating variance trends.
• Uses the out-of-model guidance matrix to assist with accurately and consistently reporting over-allowed variances to leadership and finance.
• Learns and familiarizes payer policies and contractual terms associated with the payer to which the analyst is assigned.
• Researches refund requests sent via correspondence cross-workflow, appropriately responds, and/or takes action.
• Inquires with leadership and the contract management team on potential contract term discrepancies.
• Communicates regularly with the management team regarding payer variance issues.

Skills

Healthcare revenue cycle

Analytical abilities

Communication skills

Teamwork

Independent work

Education

High school diploma or equivalent

Tools

Excel

Word

Medical terminology

Job description

US Anesthesia Partners, Inc. is seeking a Payer Compliance Specialist I – RCM to analyze allowed amounts, determine contract compliance, and process variances.

The role involves reviewing electronic and manual postings, appealing for re-processing, and resolving payer issues to maximize receivables. Candidates must have strong Excel/Word skills, healthcare revenue cycle experience, and the ability to work independently under deadlines.