Insurance Payer Specialist

Job Title: Insurance Payer Specialist

Location: Sunnyvale, CA

Pay Range: $30 - $40 per hour on w2

Job ID#: 139980

Responsibilities:

• Perform health insurance payer analysis with respect to medical billing and reimbursement functions
• Explore and update key healthcare industry payers trends at both macro and micro levels
• Define payer policies, coverages, pay rates for procedures,
• Update internal and external stakeholders with policy changes in a timely manner
• Annually updates insurance payment rates for each CPT/HCPCS code.
• Execute the implementation of assigned projects or operational issue resolution
• Meet tight deadlines in a time sensitive and resource-constrained project environment
• Build payer coverage dashboard with payer benefits and PFS rate
• Advancing payer relationships by keeping up to date with payer policy changes
• Follow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO/PPO, etc.
• Engage in end-to-end revenue cycle management process, including Eligibility verification, Authorization, charge entry, claim submission (including 837's and 1500 forms), payment posting, and accounts receivable management and extract reports from billing software
• Understanding the EOB & ERA
• Engage in follow-ups with insurance companies and medical groups to address denials and payer coverage issues
• Develop, implement, and execute departmental procedures and processes
• Generate reimbursements and analyze the revenue data to report trends related to errors & denials
• Strong data mining skill to identify trends, areas for improvement, and opportunities for revenue growth
• Analyze and identify opportunities to optimize revenue capture and reduce revenue leakage
• Ensure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to ensure accurate and compliant billing practices
• Conduct detailed data audits and clean-up as scheduled and as needed
• Conduct payer coverage training for internal stakeholders and maintain adequate documentation of meeting
• Implement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience for customers
• Collaborate with IT teams to implement technology enhancements that improve billing & revenue efficiency
• Maintain organized documentation of all billing and invoicing activities
• Sending out invoices and maintaining a tracking system of incoming and late payments
• Collaborates with internal teams, supporting the efforts and needs of other departments by providing assistance in a team-oriented approach
• Maintain compliance with HIPAA(Health Insurance Portability and Accountability Act of 1996)
• Must be a gatekeeper of the payer research and knowledge gained
• Perform other related duties as required or requested

Minimum Qualifications

• Bachelor's degree in accounting, healthcare administration, finance, business, or related field, with 5+ years of experience in an office environment or healthcare-related field
• Knowledge of CPT/ICD-10/HCPCS codes and EHR systems
• Proficient in medical terminology and insurance plans
• Experience with process improvement, quality control, data analysis and/or reporting
• Integrity and respect for confidentiality and privacy
• Attention to detail and the ability to work with a variety of databases
• Leadership skills, including presenting and representing Payer Knowledge both internally and externally
• Demonstrates the ability to work independently, is self-motivated, and self-directed with excellent verbal and written communication and documentation skills
• Demonstrates strong organizational and time management skills, enabling effective prioritization of workflow to meet client requirements.
• Possesses excellent customer service skills to ensure client satisfaction.
• Ability to analyze problems and devise strategic solutions
• Strong computer literacy with using Google Docs, Sheets, Slides and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)

About Us:

Founded in 2009, IntelliPro stands as a global leader in talent acquisition and HR solutions. Our commitment to delivering unparalleled service to clients, fostering employee growth, and building enduring partnerships sets us apart. With a dynamic presence in the USA, China, Canada, Singapore, Philippines, UK, India, Netherlands, and Germany, we continue to lead the way in global talent solutions.

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