Payer Compliance Specialist I

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 management escalation • Gather appeal documentation and file appeals to appropriate payers • Follow up on appeal results 45–60 days after submission • Partner with leadership to research and report systemic payer issues creating variance trends • Use the out-of-model guidance matrix to report over-allowed variances accurately and consistently to leadership and finance • Learn and apply payer policies and contractual terms • Research refund requests, respond appropriately, and take necessary action • Inquire with leadership and contract management about potential contract-term discrepancies • Communicate regularly with management regarding payer variance issues

🎯 Requirements

• High school graduate or equivalent required • Minimum of 2 years of experience in healthcare revenue cycle • Functional knowledge of Excel and Word required • Basic knowledge of managed care programs and healthcare billing requirements • Ability to identify and resolve payer underpayments related 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 • Ability to meet deadlines, handle multiple tasks, and manage potentially stressful situations • Ability to perform the physical requirements, with or without reasonable accommodation • US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska

🏖️ Benefits

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