POSITION SUMMARY:

The Payer Compliance Analyst I plays a key role within USAP. This position is responsible for analyzing allowed amounts received on USAP claims to determine appropriateness per contract. This individual will review electronic and manual postings associated with variances, appeal for reprocessing and/or request corrections as necessary for USAP to receive full allowance per contract. Additionally, this individual is responsible for working to identify and resolve payer issues that negatively impact receivables. He/she must have a thorough understanding and working knowledge of USAP contracts and payer reimbursement policies associated with the payer to which they are assigned. This individual has
responsibility for primary identification of payer issues. The Payer Compliance Analyst I frequently communicates with various internal USAP RCM departments as well as insurance companies. Therefore, it is essential that the candidate demonstrates a positive demeanor, professionalism and has polished verbal and written communication skills. The position requires independent thinking, problem solving and strong interpersonal skills. Additionally, this position requires good analytical skills to identify trends and issues along with possible solutions. It is important for the Payer Compliance Analyst I to have the ability to meet deadlines and other requirements set forth by the Management Team. The candidate must be able to handle potentially stressful situations and multiple tasks at one time.

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

• Follow the Payer Compliance Management standard operating procedures
• Analyze, evaluate, and validate payer under and over allowable variances in workqueues
• Take corrective actions to resolve the variances via appeal, cross-workflow, or escalation to management
• Gather appeal documentation and file appeals to various payers as appropriate
• Follow-up on appeal results 45-60 days post appeal submission
• Partner with Leadership to research and report payer systemic issues creating variance trends
• Use the out-of-model guidance matrix to assist with accurately and consistently reporting over allowed variances to Leadership and finance
• Learn and familiarize payer policies and contractual terms associated with the payer to which the analyst is assigned
• Research refund requests sent via correspondence cross-workflow and appropriately respond and/or take appropriate action
• Inquire with Leadership and the Contract Management team on potential contract term discrepancies
• Communicate regularly with the Management Team regarding payer variance issues

REPORTING TO THIS POSITION: No direct reports

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

• Skill in computer applications including MS Word, MS Excel
• Basic knowledge of managed care programs and healthcare billing requirements necessary
• Analytical abilities required to identify and resolve underpayments relating to specific payers, coding issues, etc.
• Good mathematical skills
• Skill in verbal and written communication
• Skill in gathering and reporting information
• Must display teamwork attitude and good inter-personal 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

EDUCATION/TRAINING/EXPERIENCE:

• High School graduate or equivalent
• Minimum of two years of experience in healthcare revenue cycle
• Functional knowledge of Excel and Word is required

PHYSICAL REQUIREMENTS:

• Requires prolonged sitting, some bending, stooping and stretching
• Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment
• Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations
• Requires lifting papers and boxes weighing up to 35 pounds occasionally
• Requires dexterity to type at least 35 wpm

WORKING CONDITIONS (environment and safety):

• Work performed in office environment
• Involves frequent contact with professional staff and managed care organizations
• Work may be stressful at times
• Interaction with others is frequent and often disruptive

DISCLAIMER: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.

Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.