Healthcare Insurance Analyst

2 weeks ago

Sunnyvale, California, United States IntelliPro Group Inc. Full time
Job Overview

Position Title: Insurance Payer Specialist

Location: Remote

Compensation: $30 - $40 per hour on w2

Job Responsibilities:

  • Conduct thorough analysis of health insurance payers concerning medical billing and reimbursement processes.
  • Research and stay updated on significant trends within the healthcare payer landscape at both macro and micro levels.
  • Establish and communicate payer policies, coverage details, and payment rates for various medical procedures.
  • Ensure timely communication of policy updates to both internal and external stakeholders.
  • Review and adjust insurance payment rates annually for each CPT/HCPCS code.
  • Oversee the execution of designated projects and resolve operational issues as they arise.
  • Work efficiently under tight deadlines in a fast-paced project environment.
  • Create and maintain a payer coverage dashboard that outlines payer benefits and pricing structures.
  • Enhance payer relationships by remaining informed about changes in payer policies.
  • Adhere to all regulations and guidelines established by Medicare, state programs, and various health plans.
  • Participate in the complete revenue cycle management process, including eligibility verification, authorization, charge entry, claim submission, payment posting, and accounts receivable management.
  • Understand and interpret Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).
  • Engage with insurance companies and medical groups to resolve denials and coverage issues.
  • Develop and implement departmental procedures and workflows.
  • Analyze revenue data to identify trends related to errors and denials, and generate reimbursements.
  • Utilize strong data mining skills to pinpoint areas for improvement and opportunities for revenue enhancement.
  • Ensure compliance with healthcare billing regulations and stay updated on changes in billing and coding guidelines.
  • Conduct detailed audits and data clean-up as necessary.
  • Provide training on payer coverage to internal stakeholders and maintain comprehensive documentation of training sessions.
  • Implement strategies aimed at improving claim acceptance rates and minimizing denials.
  • Collaborate with IT teams to enhance technology that boosts billing and revenue efficiency.
  • Maintain organized records of all billing and invoicing activities.
  • Manage the invoicing process and track incoming and overdue payments.
  • Work collaboratively with internal teams to support the needs of various departments.
  • Uphold compliance with HIPAA regulations.
  • Act as a steward of the payer research and knowledge acquired.
  • Perform additional related duties as assigned.

Qualifications:

  • Bachelor's degree in accounting, healthcare administration, finance, business, or a related field, with a minimum of 5 years of experience in an office or healthcare environment.
  • Familiarity with CPT/ICD-10/HCPCS codes and electronic health record systems.
  • Proficient understanding of medical terminology and various insurance plans.
  • Experience in process improvement, quality control, data analysis, and reporting.
  • Demonstrated integrity and respect for confidentiality.
  • Strong attention to detail and ability to work with diverse databases.
  • Leadership capabilities, including effective communication of payer knowledge internally and externally.
  • Ability to work independently and self-motivate, with excellent verbal and written communication skills.
  • Strong organizational and time management skills to prioritize workflow effectively.
  • Exceptional customer service skills to ensure client satisfaction.
  • Analytical skills to identify problems and develop strategic solutions.
  • Proficient in Google Docs, Sheets, Slides, and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel).

About IntelliPro Group Inc.:

IntelliPro Group Inc. is a global leader in talent acquisition and HR solutions, dedicated to providing exceptional service to clients and fostering employee development. With a presence in multiple countries, we are committed to connecting individuals with rewarding career opportunities.

As an Equal Opportunity Employer, IntelliPro values diversity and is committed to inclusivity in our hiring practices. We ensure that our processes accommodate the needs of all applicants, promoting a workplace that embraces individuals of all abilities.

Compensation: The compensation offered to successful candidates will be determined based on various factors, including education, experience, location, job responsibilities, and certifications. IntelliPro also provides a comprehensive benefits package, subject to eligibility.

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