Payment Analyst

The Payment Analyst will work closely with the Claims Analyst and act as a key liaison between the Financial Operations, Network, Payer, and Operations teams. This individual will apply their DME claims industry expertise across multiple initiatives. They’ll be responsible for investigating unapplied payment issues as well as supporting the payment integrity functions of the organization. In addition, they will work cross functionally to identify potential solutions for any issues identified. The Payment Analyst will have a natural desire to improve the status quo and will have an interest in combining data driven insights with their healthcare expertise to drive business outcomes.
Salary: $54,000/Annually
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The Payment Analyst responsibilities include but are not limited to:

• Assist in investigating any Electronic Remittance Advices (ERA)/835 issues with our clearinghouse, payer clearinghouse or payer directly to ensure seamless delivery of 835s
• Coordinate payer/provider outreach to obtain missing information needed to be able to apply payments or recoupments received.
• Assist the payment posting team with identifying, researching, and ensuring timely processing of large payment projects, ensuring payments, denials, and recoupments are appropriately applied.
• Investigating the source of unapplied payments to ensure they are applied to the correct claims.
• Provide expertise on CMS and state Medicaid guidelines for informing reports & processes on DME unit allowable and frequency guidelines.
• Assist with the testing of new payers added to the payment integrity monitoring workstreams.
• Help coordinate the initial outreach and follow-ups for actionable insights from payment integrity monitoring.
• Review samples of denial trends to assist with identifying whether a denial is Payer or Provider driven.
• Provide interpretation of claim supporting documentation to validate denials received.
• Measure provider driven billing trend changes and develop ability to track progress.
• Assist with the managing of payment posting inventory across several workstreams.

EDUCATION: Bachelor’s degree desired or equivalent experience.
EXPERIENCE:

• Ability to work well in a high-growth, fast-moving, entrepreneurial environment.
• Desire to come in and implement new processes.
• Excellent written and verbal communication skills.
• Proven ability to build strong partnerships across the organization, influence others, and work collaboratively within a team-oriented environment.
• Possess the willingness and ability to get beyond the obvious causes of outliers - and investigate, identify, and summarize the underlying root causes.
• Efficient time and resource management skills to ensure that the service level provided exceeds expectations with a strong commitment to team success and team goals.
• Comfort with ambiguity and ability to effectively multi-task, make tradeoffs, take initiative, and prioritize within a fast-paced, demanding environment.
• Familiarity with the 1500 claim forms, and DMEPOS services.
• Knowledge of ICD-10, HCPCS, and medical terminology.
• Understanding of CMS guidelines, and Medical Policy adopted by the plans.
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
• Possess investigative skills to independently conduct all claims and payment reviews, as well as other insurance related investigations.