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Payor Intelligence Specialist
2 months ago
Location: Stewardship Health Inc
Job Type: Full Time
Department: TexasLouisiana Accounts Receivable MCSET
Reports to: Manager, Accounts Receivable
Job Summary:This role will assist in the development and maintenance of a repository of information on payor-specific reimbursement behavior and policy. The Payor Intelligence Specialist will establish relationships with government and commercial health plans to proactively capture upcoming changes to reimbursement policies and procedures and resolve emerging issues affecting professional reimbursement.
Key Responsibilities:- Assist in the development of detailed strategic analysis of professional reimbursement, including assessment of changes to payment policies, pattern recognition across payors/providers, 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.
- Prepare monthly newsletter and ad hoc communication materials to providers, operations personnel, revenue cycle colleagues, and others about changes to payor policies, reimbursement, and contract language.
- Provide input to the SMG Provider Education team to assist with provider and practice training materials.
- Lead SMG discussions with third-party payors regarding reimbursement issues and underpayments.
- Review related contract language, payer policies, and procedures, fee schedules, and coding policies in collaboration with Finance and Revenue Cycle colleagues.
- Serve as a resource for questions from colleagues and constituents regarding reimbursement and related issues.
- 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.
