US Anesthesia Partners

  • EVG Appeals Specialist (Payer Compliance)

    Metro Area Denver, CO
    Job ID
    2018-2207
    Location
    US-CO-Greenwood Village
    Function
    Revenue Cycle Management
    Employment Status
    Full-Time
  • Overview

    EVERGREEN POSTING

     

    US Anesthesia Partners is currently experiencing considerable growth.  We are hiring candidates throughout the revenue cycle management process.  We offer growth opportuinties, a comprehensive benefits package, competitive salaries and bonus potential. All new hires must submit to and pass a pre-employment drug screen and background check. 

    Responsibilities

     

    The payer compliance analyst plays a key role withing the CBO.  This position is responsible for analyzing allowables received on USAP claims to determine appropriateness per contract.  This individual will review electronic and manual adjustments posted tothe patient accounting system and 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. 

     

    The Payer Compliance Analyst has frequent and direct contact with various CBO departments, as well as, insurance companies and therefore it is essential that the candidate demonstrates a positive demeanor, good verbal and written communication skills, and is professional in both appearance and approach.  The position requires independent thinking skills, good interpersonal skills, problem-solving abilities and an understanding of the operational needs of the CBO revenue cycle and its strategy.  Additionally, this position requires good analytical skills to identify trends and issues, as well as to identify possible solutions to address any issues. It is important that the Payer Compliance Analyst is able to meet deadlines and other requirements set 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):

    • Weekly review of Analyzer payer reports – identify service lines for bulk (spreadsheet) appeal, service lines for billing review/correction, forward denied services to A/R – for the following payers, as of March 1, 2009:
    • Aetna
    • BCBS
    • ChoiceCare (Humana)
    • Cigna
    • United HealthCare
    • Medicaid
    • Medicare
    • Other
    • TriCare
    • Workers’ Comp
    • Coordinate with A/R department, to update Analyzer parameters, such as establishing additional calculations or changing existing calculations in accordance with payer policy.
    • Review payer reimbursement policies to determine impact on Analyzer calculations. 
    • Inform the Management Team of any problems or changes in payer performance.  Exercise independent judgment to analyze and report repetitive payer failures so corrective actions can be taken.
    • Utilizing the Analyzer application, analyze and evaluate payer allowables. Review and track claim underpayments to identify and resolve existing or potential issues that would impact revenue. Communicate issues to Management Team.
    • Well-developed problem solving skills, including the ability to identify appropriate payer solutions, and follow through with contacting the payer for project assignment.  Responsible for review of completed project assignment upon receipt.
    • Document actions in format appropriate to task
    • Maintain a positive working relationship with contacts at all agencies, insurance companies, government entities, providers, other CBO staff and management, to promote teamwork, cooperation, and a positive image.
    • Possess exceptional communication and interpersonal skills in order to effectively interact with customers, department management and CBO staff.
    • Stay abreast of the latest developments, advancements, and trends in the field of revenue cycle management by reading professional journals and insurance newsletters.   Integrate knowledge gained into current work practices.
    • Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact billing.
    • Attend scheduled department meetings and training sessions. 
    • Identify repetitive payer- and/or internal billing occurrences for resolution of on-going items
    • Maintains strictest confidentiality.
    • Other duties, as assigned

    Qualifications

    • High School graduate or equivalent
    • Minimum of three years of experience in a healthcare business office, specifically collections and/or payment posting, is required.
    • Functional knowledge of Excel and Word is required.

     

     

    US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

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