Revenue Payor Specialist

Essential Job Responsibilities:

• Evaluate new and existing payers/networks and their fee schedule for participation.

• Proactively monitors payor medical policy updates and ensures those are applied to daily processes.

• Collaborates with revenue and credentialing on enrollment of NPI's for EDI submissions and imports of ERNs into billing software.

• Inputs all new insurance payors contracted/non-contracted in billing software.

• Ensures operations are conducted in a manner that is consistent with overall department protocol, and in compliance with Federal, State, and payer regulations, guidelines, and requirements.

• Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.

• Reports all concerns or issues directly to Director of Revenue.

Experience:

• Minimum of four (5) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system, with a deep understanding of insurance medical/fee schedule policies and regulations experience preferred.

Knowledge/Abilities:

• Strong knowledge of payor reimbursement and medical policies

• Strong excel, analytical, problem-solving, and communication skills.

• Detailed-oriented with the ability to work independently and meet deadlines.

• Working knowledge of CPT and ICD9 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.

• Up to date with health information technologies and applications.

• Must be proficient in Microsoft Office, including Outlook, Word, and Excel.

• Ability to communicate effectively in writing, over the telephone, and in person.

Work Environment:

• Position is in well-lighted office environment. Occasional evening and weekend work may be required.