Payor Intelligence Specialist

3 weeks ago

Watertown, Massachusetts, United States IASIS Healthcare Full time
Job Summary:

As a Payor Intelligence Specialist at IASIS Healthcare, you will play a critical role in developing and maintaining a repository of information on payor-specific reimbursement behavior and policy. This position requires strong investigative skills, intellectual curiosity, and the ability to understand complex topics related to professional reimbursement policy changes.

Key Responsibilities:

* Assist in the development of detailed strategic analysis of professional reimbursement, including assessment of changes to payment policies and ability to diagnose complex reimbursement problems.
* Develop presentation materials to lay out the context of issues related to professional reimbursement, including relevant facts and analysis, to inform decision makers.
* Facilitate discussions of various options, including quantitative evidence and workflow recommendations, to optimize reimbursement outcomes.
* Prepare monthly newsletter and ad hoc communication materials to providers, operations personnel, and revenue cycle colleagues about changes to payor policies and reimbursement.
* Serve as a resource for questions from colleagues and constituents regarding reimbursement and related issues, and manage the process for responding to ad hoc requests in a timely manner.

Requirements:

* Bachelor's degree in a related field, such as healthcare administration or business.
* Two or more years of experience in professional claim reimbursement/analysis.
* Subject matter expertise in payor contracts and reimbursement methodologies, health plan operations, and/or claims processing.
* Strong knowledge of professional reimbursement, including charge capture, coding, and A/R follow up.
* Strong organizational skills to develop an easily searchable and sustainable repository of detailed payor intelligence and data.
* Creativity and deductive reasoning skills to triangulate root causes of claim issues.
* Ability to be persuasive and use data to effectively advocate a position with a payor to maximize payment and financial performance.
* Outstanding documentation and communication skills to relay detailed technical information in a succinct, actionable manner.

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