Payer Excellence Coordinator

AbleNet•Saint Paul, MN

5d•Remote

About The Position

The Payer Excellence Coordinator is responsible for timely submission and of all medical insurance claims to commercial, government, and contracted payers. This role focuses on submitting clean claims, improving clean-claim performance through root-cause analysis and closed-loop learning, managing medical records requests, and verifying the status of outstanding claims to ensure timely resolution. The Payer Excellence Coordinator must understand and comply with federal and state billing regulations including protected diagnosis codes as defined under HIPPA Policies and Procedures. The Payer Excellence Coordinator 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 Coordinator will work collaboratively with the other AbleNet staff to provide a continuous improvement of the medical claims.

Requirements

Detailed oriented, organized, and self-starter
Ability to work in a team environment and independently as required.
Proficient with computer skills-computer programs, spreadsheets, and applications
Excellent communication skills in verbal and writing
Electronic billing
Knowledge of medical insurance
Knowledge of traditional insurance plans, HMO/PPO’s, Medicare, and Medicaid
Bachelor’s degree preferred or equivalent work experience
4+ years of experience in medical billing/ claims processing or submission

Nice To Haves

Medical billing certification preferred

Responsibilities

Submit 100% of insurance claims through both automated (Niko) and manual processes based on submission framework outlined by leadership
Manage and respond to medical records requests from payers in a timely and accurate manner.
Perform claim status verification framework outline by leadership
Ensure claims are accurate, complete, and compliant to maximize first-claim acceptance.
Track trends and identify opportunities to improve first-claim acceptance.
Contributes to the overall operations and to the achievement of departmental goals
Demonstrate the core operation of department philosophies: Listen, Learn and Lead
Perform backup support for other members of the team department.
Effective communication with patients, insurance companies, and healthcare providers
Embrace AbleNet’s culture and 7 rules of engagement
Adhere to all practice policies related to HIPAA and Medicare Compliance
All other duties as assigned