Payer Compliance Specialist I

🕒 September 23

🇺🇸 United States – Remote

💵 $16 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚔 Compliance

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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US Anesthesia Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2012

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

US Anesthesia Partners is a leading provider of comprehensive anesthesia services, dedicated to delivering exceptional patient care and operational excellence. Founded by a team of forward-thinking anesthesiologists, USAP specializes in various anesthesiology areas including cardiovascular care, obstetrics, and pediatrics. With a network of thousands of clinicians and hundreds of facility partners across the nation, they serve over two million patients annually, aiming to redefine the standards of quality in anesthesia services.

📋 Description

• Follow payer compliance management standard operating procedures • Analyze, evaluate, and validate payer under- and over-allowable variances in work queues • Manage corrective actions through appeals, cross-workflow, or escalation to management • Gather appeal documentation and file appeals with payers • Follow up on appeal results 45–60 days after submission • Partner with leadership to research and report payer systemic issues creating variance trends • Use the out-of-model guidance matrix to report over-allowed variances to leadership and finance • Learn payer policies and contractual terms • Research and respond to refund requests and take appropriate action • Inquire with leadership and contract management about potential contract term discrepancies • Communicate regularly with management about payer variance issues • Communicate with internal RCM departments and insurance companies • Identify and resolve payer issues negatively impacting receivables

🎯 Requirements

• High school graduate or equivalent required • Minimum of 2 years experience in healthcare revenue cycle • Functional knowledge of Excel and Word required • Basic knowledge of managed care programs and healthcare billing requirements • Analytical abilities to identify and resolve underpayments relating to specific payers and coding issues • Good mathematical, verbal, and written communication skills • Experience gathering and reporting information • Teamwork attitude and 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 • Must be able to meet the physical requirements of the job, with or without reasonable accommodation • Must be able to communicate verbally and in writing • Candidates residing in California, Hawaii, or Alaska are not hired

🏖️ Benefits

• Quarterly bonus eligibility • Equal employment opportunities • Reasonable accommodations for individuals with disabilities