Payer Compliance Specialist I - Remote

About the role

The Payer Compliance Specialist I – RCM analyzes allowed amounts received on USAP claims to determine appropriateness per contract, reviews electronic and manual postings associated with variances, appeals for re‑processing, and requests corrections as needed to ensure USAP receives the full allowance per contract. The role also works to identify and resolve payer issues that negatively impact receivables, frequently communicates with internal USAP RCM departments and insurance companies, and requires a positive demeanor, professionalism, and polished verbal and written communication skills. Independent thinking, problem solving, strong interpersonal and analytical skills are needed to identify trends and issues and develop solutions. The specialist must meet deadlines set by management, handle stressful situations, and juggle multiple tasks simultaneously. Note: US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska.

Responsibilities

• Follows the payer compliance management standard operating procedures.
• Analyzes, evaluates, and validates payer under and over‑allowable variances in work queues.
• Manages corrective actions to resolve variances via appeal, cross‑workflow, or escalation to management.
• Gathers appeal documentation and files the appeal to various payers as appropriate.
• Follows up on appeal results 45‑60 days post appeal submission.
• Partners with leadership to research and report payer systemic issues creating variance trends.
• Uses the out‑of‑model guidance matrix to assist with accurately and consistently reporting over‑allowed variances to leadership and finance.
• Learns and familiarizes payer policies and contractual terms associated with the payer to which the analyst is assigned.
• Researches refund requests sent via correspondence cross‑workflow, appropriately responds, and/or takes action.
• Inquires with leadership and the contract management team on potential contract term discrepancies.
• Communicates regularly with the management team regarding payer variance issues.

Qualifications

• 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 necessary.
• Analytical abilities to identify and resolve underpayments relating to specific payers, coding issues, etc. are required.
• Good mathematical, verbal, and written communication skills.
• Experience gathering and reporting information.
• Must display a teamwork attitude and possess 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.

Pay

The base pay estimate for this role is $16.49 - $26.39 hourly. The final offer will depend on the skills, experience, and qualifications of the selected candidate. This range is for base pay only and does not include bonuses or other compensation. This position is eligible for a quarterly bonus; bonuses are not guaranteed and are awarded based on company and individual performance.