Fort Worth, Texas
Revenue Cycle Analyst (Payer Analyst) Job Opening in Fort Worth, Texas - Job Summary
Under general supervision, is responsible for all post treatment financial follow up. Investigates, researches, analyzes and assertively collects outstanding insurance balances by working on complex appeals to bring resolution to each account, while maintaining the highest level of professionalism and confidentiality. This job would require a person to identify trends, patterns of claims & work with the providers, payers and the organization management to suggest changes to the work-flow to increase first pass cash.
Key Responsibilities
Handles complex procedures within the revenue cycle including but not limited to coding, collections, postings
Ability to independently identify areas of concern regarding various areas of the RCM. Analyze trends and issues and propose action to resolve
Interpret payer specific clinical guidelines to support appeals and escalations. Review and assist with claims appeals as needed
Work directly with offshore teams to resolve/reduce outstanding A/R
Develop, improve and maintain relationships with payer relations representatives
Work directly with payer relations representatives to address claims issues identified thru reporting and trending. Attend monthly scheduled payer calls and efficiently address payer escalation issues
Work with client to manage and maintain Insurance profiles in Next-Gen
Work with client Contracting and Credentialing departments when escalations/trends are identified (underpayments, credentialing denials etc.,)
Work directly with Physicians and assigned staff to secure required signatures, letters of Medical Necessity, review of recommended coding changes for approval etc.,
Work with coding teams to address potential coding changes and corrections
Communicate effectively with Attorneys, W/C case managers to secure treatment authorizations, resolve outstanding claims issues as they relate to No Fault policies, Worker?s Compensation guidelines etc.
Qualification
Required
High School or Equivalent, Bachelors preferred (Healthcare Administration)
Minimum of Five years of directly related RCM experience in a large CBO environment is a must
Candidate should possess Good knowledge on Excel, Next-Gen
Knowledge coding guidelines (CPT and ICD-10) with ability to interpret payer guidelines, LCD?s and LMRP?s.
Knowledge of US Healthcare Insurance, Medicare, Medicaid, Worker?s Compensation and Commercial products (Managed Care, HMO, PPO etc.,)
Good analytical skills
Excellent verbal and written communications skills
Strong personality to be able to push back in a polite manner but continue to focus on the goal
Well-organized, highly efficient, keen eye for detail
Work effectively in diverse group of people as well as individually
Highly trainable, Quick learner, adaptive to changes and pressure in the organization
Strong attention to detail, along with the ability to analyze and understand large amounts of data
Ability to perform well under pressure, adapt to change, and meet deadlines in a fast-paced environment.
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
Revenue Cycle Management: 5 years
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