Payor Analyst

You could say Brightree by ResMed is a technology company. And that's true. But Brightree is, at its heart, about people. We develop innovative, end-to-end technology solutions and services for people facing everyday challenges in the post-acute care industry. Brightree helps streamline processes, improve efficiency, and increase profitability. For over fifteen years, organizations big and small have put their trust in us-for our wide-ranging solutions, our leadership, and our unmatched customer service. Going to work each day and creating new ways to positively impact our customers' businesses and the lives of patients is just what we do. Because Brightree is, after all, about people.

To learn more about Brightree technology and solutions watch this short video by our CEO: https://www.brightree.com/whychoosebrightree

Payor Analyst is responsible for financial results of the insurance companies and Brightree customers. In addition, this role is, responsible for identifying and following policies, procedures and systems for quality assurance as directed by Medicare, Medicaid and Private insurance. Assist in creating and revising our standard operating procedures and educate our partners, worldwide vendors, and internal teams on those procedures. Responsible for quality assurance of work performed by internal team members.

Let's talk about Responsibilities

• Understanding all general rules, guidelines, and methods to get optimal reimbursement from the insurance companies for which they are assigned
• Responsible for resolving and routing incoming salesforce cases from customers
• Responsible for the financial results of the insurance companies and Brightree customers by ensuring accuracy:
  • Reducing Credit Adjustments and write Off's
  • Ensure that the billing methodology for each payer is documented and set-up throughout the Brightree system to realize maximum reimbursement
  • Propose changes and updates to the configuration of the customers Brightree system including but not limited to
    • Price tables
    • Insurance Settings
    • Modules adoption
    • Additional Services
  • Identifying areas of opportunities to better streamline internal or external processes
    • System Enhancements to the Brightree System
    • Process improvements to increase efficiency
• Continuously improve current business and system processes by creating, redefining, and maintaining standard operating procedures (SOPs) to ensure maximum efficiency in business and system processes; seek input on improved strategies and processes to help achieve goals; implement new processes and system practices to achieve the goal of reducing time to market for new products while maintaining the highest quality products in the market.
• Assist in the onboarding and offboarding of our clients from the different Brightree systems.
• Prepares and submits reports to team lead as needed including but not limited to:
  • Quality Assurance Reporting
  • Denial Analyst Reporting
  • Service Level Agreement Reporting
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals
• Collaborates with worldwide resources to ensure effective knowledge, information sharing, and quick resolution of service performance issues.
• Maintains patient confidentiality and function within the guidelines of HIPAA
• Other tasks and responsibilities as assigned

Let's talk about Qualifications and Experience

Required:

• High school diploma required; equivalent combination of education and experience will be considered
• Minimum of 2 years of home infusion billing or accounts receivable experience required
• Minimum of 2 years of experience working in & maintaining HIPAA standards
• Highly skilled in using computers & Microsoft products (Excel and Word) is required
• Highly motivated in billing, claims, denials and document management to work with our internal and external customers on the phone or via software applications
• Math aptitude
• Strong problem-solving skills focused on resolving complex home infusion claims
• An effective communicator with strong oral, written and persuasive skills and capability to deal with people at all levels in the organization and the public in a professional manner
• Exceptional organizational skills with a high level of attention to detail and the ability to multitask
• Self-starter, results driven, highly motivated, high energy
• Proven track record of working towards and exceeding metrics strongly preferred

Preferred:

• A 2-year degree or additional college coursework

• 5 years of experience in a healthcare reimbursement role

Joining us is more than saying "yes" to making the world a healthier place. It's discovering a career that's challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now!