Payer Excellence Analyst
About The Position
The Payer Excellence Analyst is responsible for resolving denied claims cases. This role will provide analysis of denied claims while maintaining standards of federal regulations to ensure correct billing practices are adhered to. Payer Excellence Analyst role requires 100% adherence to the denial management framework that is outlined by leadership. The Payer Excellence Analyst is accountable for managing an assigned inventory of files, driving claims to timely resolution, and achieving defined key performance indicators (KPIs) related to aging, recovery, and closure outcomes. They will respond to internal and external medical customer inquiries related to claims in a timely manner while demonstrating the core medical department philosophies: Listen, Learn and Lead. The Payer Excellence Analyst will work collaboratively with the other AbleNet staff to provide a continuous improvement of the medical claims.
Requirements
- Self-motivated with the ability to work independently and within a team environment
- Strong analytical, problem-solving, and decision-making skills
- Ability to manage volume-driven workloads in a metric-based environment
- Strong attention to detail with consistent documentation practices
- Excellent written and verbal communication skills
- Ability to apply general rules to specific claim scenarios to produce accurate outcomes
- Ability to multitask efficiently and accurately under pressure
- Ability to adapt to a fast-changing environment
- Proficient working knowledge of claims systems, Microsoft Office products, and supporting databases
- Strong computer skills with the ability to learn new systems and claims platforms
- Data entry and account management experience
- Bachelor’s Degree required
- 3+ years of medical billing and/or claims processing/submission experience: general knowledge of industry forms and files, CPT and ICD10 coding knowledge and familiarity with medical terminology.
Nice To Haves
- Medical billing certification preferred.
Responsibilities
- Analyze, research, correct, and resubmit denied or rejected claims for federal, state, and private insurance in accordance with established workflows and timelines
- Follow the denial management framework 100% of the time
- Perform daily file-level analytical work to drive claims toward resolution and reimbursement
- Perform proactive follow-up, status checks, and payer outreach on unpaid or underpaid claims
- Document all claim actions, outcomes, and communications accurately and timely
- Monitor claim aging and prioritize work to ensure optimal resolution within the framework
- Identify submission errors, payer trends, and recurring denial issues and report findings to leadership
- Respond to internal and external inquiries related to claim status via phone, email, fax, or written correspondence
- Coordinate with accounting and finance teams to resolve claim-related payment or reconciliation issues
- Work collaboratively with all Payer Excellence team members to support team-level performance and workload alignment
- Demonstrate the core medical department philosophies: Listen, Learn, and Lead
- Incorporate the organization’s 7 rules of engagement into daily work
- Complete final resolution of complaints, grievances, and appeals within established timelines
- Assist as backup support for senior coordination functions, including casing mail, billing claims, and managing claims inboxes, as assigned
- Adhere to all practice policies related to HIPAA and Medicare Compliance
- Perform other duties as assigned by management
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
