Perform health insurance payer analysis 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 on 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
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.
IntelliPro, a global leader in connecting individuals with rewarding employment opportunities, is dedicated to understanding your career aspirations. As an Equal Opportunity Employer, IntelliPro values diversity and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other legally protected group status. Moreover, our Inclusivity Commitment emphasizes embracing candidates of all abilities and ensures that our hiring and interview processes accommodate the needs of all applicants. Learn more about our commitment to diversity and inclusivity at https://intelliprogroup.com/.
Compensation: The pay offered to a successful candidate will be determined by various factors, including education, work experience, location, job responsibilities, certifications, and more. Additionally, IntelliPro provides a comprehensive benefits package, all subject to eligibility
Seniority level
Entry level
Employment type
Full-time
Job function
Accounting/Auditing and Finance
Industries
Staffing and Recruiting
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