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Medical Insurance Payer Specialist

5 months ago

Sunnyvale, United States IntelliPro Group Inc. Full time
Job DescriptionJob Description

Company Overview

This 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 Summary

Responsibilities and Duties

  1. ● Perform health insurance payer analysis respect to medical billing and reimbursement functions
  2. ● Explore and update key healthcare industry payers trends at both macro and micro levels
  3. ● Define payer policies, coverages, pay rates for procedures,
  4. ● Update internal and external stakeholders with policy changes in a timely manner
  5. ● Annually updates insurance payment rates for each CPT/HCPCS code.
  6. ● Execute on the implementation of assigned projects or operational issue resolution
  7. ● Meet tight deadlines in a time sensitive and resource constrained project environment
  8. ● Build payer coverage dashboard with payer benefits and PFS rate
  9. ● Advancing payer relationships by keeping up to date with payer policy changes
  10. ● Follow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO/PPO, etc.
  11. ● Engage in end-to-end revenue cycle management process, including Eligibility verification, Authorization, charge entry,
  12. claim submission (including 837's and 1500 forms), payment posting, and accounts receivable management and extract
  13. reports from billing software
  14. ● Understanding the EOB & ERA
  15. ● Engage in follow-ups with insurance companies and medical groups to address denials and payer coverage issues
  16. ● Develop, implement, and execute departmental procedures and processes
  17. ● Generate reimbursements and analyze the revenue data to report trends related to errors & denials
  18. ● Strong data mining skill to identify trends, areas for improvement, and opportunities for revenue growth
  19. ● Analyze and identify opportunities to optimize revenue capture and reduce revenue leakage
  20. ● Ensure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to
  21. ensure accurate and compliant billing practices
  22. ● Conduct detailed data audits and clean-up as scheduled and as needed
  23. ● Conduct payer coverage training for internal stakeholders and maintain adequate documentation of meeting
  24. ● Implement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience
  25. for customers
  26. ● Collaborate with IT teams to implement technology enhancements that improve billing & revenue efficiency
  27. ● Maintain organized documentation of all billing and invoicing activities
  28. ● Sending out invoices and maintaining a tracking system of incoming and late payments
  29. ● Collaborates with internal teams, supporting the efforts and needs of other departments by providing assistance in a
  30. team-oriented approach
  31. ● Maintain compliance with HIPAA(Health Insurance Portability and Accountability Act of 1996)
  32. ● Must be a gatekeeper of the payer research and knowledge gained
  33. ● Perform other related duties as required or requested

Qualifications and Skills

  1. ● Bachelor's degree in accounting, health care administration, finance, business, or related field, with 5+ years of experience in an office environment or healthcare-related field
  2. ● Knowledge of CPT/ICD-10/HCPCS codes and EHR systems
  3. ● Proficient in medical terminology and insurance plans
  4. ● Experience with process improvement, quality control, data analysis and/or reporting
  5. ● Integrity and respect for confidentiality and privacy
  6. ● Attention to detail and the ability to work with a variety of databases
  7. ● Leadership skills, including presenting and representing Payer Knowledge both internally and externally
  8. ● Demonstrates the ability to work independently, is self-motivated, and self-directed with excellent verbal and written communication and documentation skills
  9. ● Demonstrates strong organizational and time management skills, enabling effective prioritization of workflow to meet client requirements. Possesses excellent customer service skills to ensure client satisfaction.
  10. ● Ability to analyze problems and devise strategic solutions
  11. ● Strong computer literacy with using Google Docs, Sheets, Slides and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)

 

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