Payor Analyst

US Digestive Health • Wyomissing, PA

2d • Onsite

About The Position

The Payor Analyst is responsible for completing complex appeals, refund audits, and payor projects. This role involves investigating rejected claims, utilizing provider websites or phone conversations to determine corrective actions, and maintaining appropriate documentation in the Revenue Cycle Management System. The analyst will also field questions from co-workers, participate in departmental communication, review claim documentation, correct coding when necessary, research trending claim denials, and stay updated on specific billing requirements to ensure appropriate claims processing and reimbursement.

Requirements

• High School Diploma or GED Equivalent
• Minimum of 2-3 years of experience in a medical or office setting.
• Must be authorized to work in the US for any employer
• Strong people skills with a warm and friendly demeanor.
• Strong organizational skills and proficiency in basic office operations to ensure appropriate documentation and follow-through.
• Proficient computer skills, including accurate data entry into Microsoft Office software and basic internet usage.
• Knowledge and/or willingness to understand insurance guidelines and requirements.
• Current knowledge of CPT/ICD10/HCPCS usage.
• Ability to review documentation to obtain basic procedural and/or diagnosis codes.

Nice To Haves

• Experience with EMR systems is preferred.

Responsibilities

• Assist in resolving denied, scrubbed, or held claims by investigating rejected claims, utilizing provider websites or phone conversations to determine corrective actions
• Maintain appropriate documentation and files regarding all patient account interactions in the Revenue Cycle Management System.
• Field questions from co-workers and staff as required.
• Actively participate in facility and departmental communication through daily review of email messages.
• Review claim documentation and correct coding when necessary.
• Recognize and research trending claim denials.
• Stay updated on specific billing requirements to ensure appropriate claims processing and reimbursement.
• Perform any other duties as assigned by the manager.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED