Payer Compliance Specialist I

This is a fully remote position, open to applicants in United States.

📋 Description

• Adhere to payer compliance management standard operating procedures.

• Assess, analyze, and confirm payer variances, both under- and over-allowable, within work queues.

• Oversee corrective measures via appeals, cross-workflow collaboration, or escalation to management.

• Collect documentation for appeals and submit them to the relevant payers.

• Follow up on the results of appeals 45–60 days post-submission.

• Collaborate with leadership to investigate and report on systemic payer issues that create variance trends.

• Utilize the out-of-model guidance matrix to accurately report over-allowed variances to both leadership and finance.

• Acquire knowledge of and apply payer policies and contractual agreements.

• Investigate refund requests, respond as needed, and take appropriate actions.

• Consult with leadership and contract management regarding any discrepancies in contract terms.

• Maintain regular communication with management concerning payer variance matters.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in the healthcare revenue cycle is essential.

• Proficiency in Excel and Word is required.

• Basic understanding of managed care programs and healthcare billing requirements is necessary.

• Capability to identify and rectify payer underpayments related to specific payers and coding issues.

• Strong mathematical, verbal, and written communication skills.

• Previous experience in gathering and reporting information.

• A collaborative mindset and effective interpersonal skills are important.

• Ability to work independently with minimal supervision.

• Familiarity with basic medical terminology and concepts is preferred.

• Knowledge of CPT, ICD-9, and ASA coding is advantageous.

• Capacity to meet deadlines, manage multiple tasks, and handle potentially stressful situations.

• Ability to fulfill physical requirements, with or without reasonable accommodation.

• US Anesthesia Partners does not employ candidates who reside in California, Hawaii, or Alaska.

🏝️ Benefits

• Eligibility for quarterly bonuses.

• Equal employment opportunities for all individuals.

• Reasonable accommodations available for individuals with disabilities.