Payer Compliance Specialist I
Skills
Analytical SkillsAvaya Site AdministrationICD-9IT EscalationMatrixgoldPayerPlays
What the job involves
The main requirements, responsibilities and hiring steps.
Requirements
- High school graduate or equivalent required
- Minimum 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 ability to identify and resolve underpayments relating to specific payers and coding issues
- 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
- Familiarity with basic medical terminology and concepts preferred
- Knowledge of CPT ICD-9 and ASA coding preferred
Nice to have
- Positive demeanor
- Professionalism
- Polished communication
- Independent thinker
- Problem solver
- Strong interpersonal skills
- Strong analytical skills
Day to day
- Analyze payer allowed amounts on claims to confirm contract accuracy and identify under- and over-allowable variances.
- Review electronic and manual postings, gather appeal documentation, and pursue reprocessing or corrections to recover full contract allowances.
- Research payer issues and variance trends, communicate findings with internal teams and insurers, and support timely resolution of complex receivables problems.