Patient Account Analyst – Payor Relations

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Establish and nurture robust working relationships with both governmental and non-governmental payers.

• Engage with payers to address and resolve outstanding accounts.

• Collaborate with contracting management to implement regulatory updates and assist with billing and collections.

• Support the management of the onsite Blue Cross BlueShield relationship.

• Maintain and regularly update the managed care contract matrix.

• Monitor operational and legislative matters that impact the organization.

• Conduct in-service and bulletin meetings while distributing payer newsletters.

• Provide education to clinical and PRMO operational leadership.

• Review payer websites and keep track of operational issues.

• Compile and disseminate the monthly payer newsletter.

• Represent DUHS and DHIP in pertinent payer engagements.

• Analyze denial reports, identify trends, and assess performance metrics.

• Investigate denial root causes utilizing account, reimbursement, and policy information.

• Identify and execute process improvements aimed at reducing denials.

• Advise operational staff regarding rejection and denial codes and the appropriate resolution actions.

• Communicate with third-party payers concerning operational and workflow-related issues.

• Develop and maintain comprehensive workflow and policy documentation.

• Stay informed about team functions, payer requirements, systems, and operational procedures.

⛳️ Requirements

• A bachelor's degree in business, healthcare administration, accounting, finance, or a related discipline is mandatory.

• At least four years of relevant experience is required.

• Prior experience in successfully managing complex projects with multiple stakeholders, demonstrating a consistent record of timely and high-quality results is preferred.

• A master’s degree in a related field may substitute for two years of experience on a one-to-one basis.

• Familiarity with relevant payer billing requirements and reimbursement regulations is essential.

• Proficient knowledge of core systems, including Maestro Care and ancillary systems like Availity, Hyland, and payer-specific portals is necessary.

• Advanced proficiency in Outlook, Excel reporting, Word processing, Visio flowcharting, PowerPoint presentations, ServiceNow Change Controls, I-forms, and API/PTO.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance packages.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuing education.

• Retirement savings plan with employer match.