Insurance Payer Specialist

Job Title: Insurance Payer Specialist
Position Type: Full-time/Permanent
Location: Sunnyvale, CA
Salary: 60k- 80k annually
Job ID #: #139980
About the job:
This position involves comprehensive analysis of health insurance payers in relation to medical billing and reimbursement functions. It is responsible for all aspects of payer research, including communicating and managing complex payer and industry changes that affect the Client’s revenue cycle for Remote Patient Monitoring, Chronic Care Management, and Medical Nutrition Therapy services, as well as its operations and strategies.
Duties and Responsibilities:

• Analyze health insurance payers related to medical billing and reimbursement.
• Monitor and update healthcare payer trends and policies.
• Update stakeholders on policy changes and annual payment rates.
• Implement projects and resolve operational issues within deadlines.
• Build and maintain a payer coverage dashboard.
• Maintain payer relationships and compliance with regulations.
• Manage the entire revenue cycle, including claim submission and follow-ups on denials.
• Conduct data audits, generate reimbursements, and analyze revenue trends.
• Provide payer coverage training and document meetings.
• Implement strategies to improve claim acceptance and reduce denials.
• Collaborate with IT to enhance billing and revenue efficiency.
• Maintain organized billing documentation and track payments.
• Support other departments and ensure HIPAA compliance.
• Serve as the gatekeeper of payer research.
• Perform other related duties as needed.

Job Requirements:
 

• Bachelor's degree in accounting, healthcare administration, finance, business, or a related field, with over 5 years of experience in an office or healthcare-related environment.
• Knowledge of CPT, ICD-10, and HCPCS codes, as well as EHR systems.
• Proficient in medical terminology and insurance plans.
• Experience in process improvement, quality control, data analysis, payer policy research and reporting.
• Integrity and respect for confidentiality and privacy.
• Attention to detail and ability to work with various databases.
• Leadership skills, including the ability to present and represent payer knowledge both internally and externally.
• Ability to work independently, self-motivated, and self-directed, with excellent verbal and written communication and documentation skills.
• Strong organizational and time management skills, enabling effective workflow prioritization to meet client requirements. Excellent customer service skills to ensure client satisfaction.
• Ability to analyze problems and develop strategic solutions.
• Strong computer literacy with 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.
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, or 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.