Payer Compliance Analyst, Full time - Days

About the role

This position is a work from home opportunity with occasional onsite requirements. Based outside of the greater Chicagoland area.

Responsibilities

• Support payer compliance documentation for dispute resolution processes with payers including mediation, arbitration, and legal actions.
• Monitor and enforce payer reimbursement compliance, including account receivable (AR) variances, requests for information, audits, denials, underpayments, and no pays.
• Maintain an electronic tracking system for payer compliance issues and claims.
• Collaborate with various staff to compile worklists and trends highlighting payer compliance issues.
• Participate in monthly payer joint operating committee (JOC) meetings and payer operational meetings, creating agenda items, tracking reports, and payer dashboards.
• Drive discussions for escalating high-level issues to identify and rectify root causes contributing to payer contract compliance.
• Provide feedback on issues to be addressed in contract negotiations, including payer policies, market trends, operational concerns, and data/analysis to strengthen negotiating positions.
• Use Epic and FinThrive to understand and monitor contractual terms and expected reimbursement to inform business intelligence and identify pattern issues for remediation and resolution.
• Continuously educate on reimbursement rules and policy updates, providing insights to internal stakeholders.

Requirements

• Bachelor's degree in business, finance, health or public administration, management, related field, or equivalent work experience.
• Minimum of seven (7) or more years of related health care experience in revenue cycle, claims, and financial analysis and contract enforcement.
• Extensive familiarity with the Illinois provider and payer market and competitive landscape.
• Direct experience performing trend/variance analyses and working with providers and third-party payers to facilitate issue resolution.
• Strong knowledge of hospital and physician revenue cycle operations, including reimbursement methodologies and coding.
• Familiarity with contract management and cost accounting systems for data gathering and model analysis.
• Excellent understanding of contract language, rate terms, physician and hospital coding and billing, claims forms, and insurance laws.

Qualifications

• Must satisfy HCFA’s requirement to submit MSP claims when no balance is due.