Senior Payer Relations - Revenue Compliance & Recovery Specialist

Lehigh Valley Health Network•Allentown, PA

10d•Onsite

About The Position

Advances Payment Compliance functions to a fully integrated enterprise model. Utilizes Subject Matter Expertise to build a scalable process utilizing Epic technology. Maintains payer relationships to strengthen payer performance. Leverage Revenue Cycle expertise to ensures system wide contract compliance, drive strategic resolution of underpaid claims, audits payor performance, and analyzes actual payments of payer. Monitors payer policies and assess their impact on the enterprise.

Requirements

Bachelor’s Degree
5 years progressive experience in billing, health insurance, physician practice, or equivalent operations environment.
Expert knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills, and collaborative skills to uncover and recover payment discrepancy in a complex system.
Computer skills, familiarity with EMR, word processing, and Excel.
Knowledge of medical billing practices.
Knowledge of healthcare work processes for revenue cycle departments and divisions.
Knowledge and thorough understanding of the revenue cycle process and how components fit together.
Knowledge and understanding of reimbursement methodologies such as fee-for-service, capitation, and case rates.

Nice To Haves

Master’s Degree
1 year work experience with providers, health plans, members, and vendors.

Responsibilities

Compares actual reimbursement to expected reimbursement across the enterprise.
Reviews managed care contract terms, claims billing details and clinical information to identify and reconcile underpaid accounts.
Supports development of system-wide payment compliance workflows and methodologies.
Builds relationships with payer representatives on behalf of the enterprise.
Facilitates consistent information flow, alignment and issue resolution, ensuring payer performance transparency across the enterprise.
Partners with Revenue Cycle, Utilization Management and Operational Leaders to identify, consolidate and escalate payer-related A/R trends.
Uses institutional experience to drive action.
Monitors, interprets and analyzes payer policy changes and emerging industry regulations impacting the organization.
Collaborates with data analytics, clinical teams and operational partners to generate deep insights and develop strategies for engagement, escalation, and dispute management.
Collaborates with stakeholders to build consistent, scalable processes that support enterprise integration and promotes optimized reimbursement.