This is a work from home position. The candidate selected must be willing to meet appropriate accommodations and high speed internet requirements.
Researches and Resolves High Dollar Insurance Payor Underpayments through concise
understanding of Payor Contract language and respective payment calculation. Position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult high dollar underpayments. Candidate will demonstrate ability to grow strategic payor relationships and obtain understanding of payor system to navigate through claims processing centers. Critical
thinking skills are necessary, as well as ability to see trends that require escalation to the Payment Compliance Director. Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action.
Director, Payment Compliance
Duties (included but not limited to):
Analyzes hospital claims to identify contractual underpayments or billing errors.
Resolves underpaid claims from various Payor products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.
Articulates contract provisions to representatives from healthcare Payor companies and government agencies.
Contacts Payor companies via phone or correspondence and initiates request for payment.
Performs appropriate follow up with Payor and gains commitment for payment.
Escalates Payor lack of response and/or lack of payment within Payor organization as appropriate.
Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
Identifies Payor company trends and communicates trends to supervisor for further action/escalation.
Serves as a subject matter expert in Payor contract dispute resolution process.
Practices and adheres to the Code of Conduct
Knowledge, Skills & Abilities
Communication - communicates clearly and concisely, verbally and in writing.
Persistence - comfortable pursuing, rebutting and escalating issues as appropriate.
Goal-oriented - holds him/herself accountable to achieving shared and personal goals.
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Interpersonal skills - able to work effectively with other employees, patients and external parties.
PC skills - demonstrates high proficiency in Microsoft Office applications and others as required.
Policies & Procedures - demonstrates knowledge and understanding of organizational policies,
procedures and systems.
Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures
Writing skills - advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.
High school diploma or GED required.
Bachelor's degree required.
Masters degree preferred.