Payor Analyst

US Digestive Health • Wyomissing, PA

13h • Onsite

About The Position

This position is responsible for completing complex appeals and payor projects as well as working with the billing vendor to ensure claims are being processed accurately. The Payor Analyst monitors rejected and denied claims to determine the root cause and works to resolve and prevent future errors. They maintain appropriate documentation and files regarding all patient account interactions, assuring timely documentation is noted in the Revenue Cycle Management System. This role also involves developing, maintaining, and providing workflows and trainings for billing vendors to ensure claims are appealed or reprocessed correctly. Other duties may be assigned by the supervisor.

Requirements

• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external patients/staff.
• Requires well developed organizational skills and basic office operations to assure appropriate documentation and follow-through to meet the patient and department needs.
• Can evaluate a variety of patient situations and make timely and decisive decisions, with minimal supervision. This includes analyzing claim data to determine the next best step in the claim filing process.
• Demonstrates proficient computer skills including accurate data entry into Microsoft Office software (Outlook, Work, Excel). Along with basic proficiency of internet usage.
• Knowledge and/or willingness to understand insurance guidelines and requirements.
• Have a current knowledge of CPT/ICD10/HCPCS usage.
• The ability to review documentation to obtain basic procedural and/or diagnosis codes.
• High School Diploma or GED equivalent
• 2+ years’ experience in medical billing and/or AR follow up

Nice To Haves

• Coding certification through AAPC preferred.

Responsibilities

• Monitors the rejected and denied claims to determine the root cause and work to resolve and prevent future errors.
• Maintains appropriate documentation and files regarding all patient account interactions, assuring timely documentation is noted in the Revenue Cycle Management System.
• Fields questions from other co-workers and staff as required.
• Actively participates in facility and departmental communication through daily review of email messages.
• Develop, maintain, and provide workflows and trainings for the billing vendors to ensure claims are being appeal or reprocessed correctly.
• Other duties as assigned by supervisor.

What This Job Offers

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