[Hiring] Payer Analyst @UBC

Role Description

The Payer Procedures and Communications Specialist is responsible for maintaining critical system files, included but not limited to Referring Doctor Files, Insurance Databases Files, and other applicable reference tools that support the reimbursement process. Additionally, assisting the audit team by pulling necessary documentation for audit or deep dive requests as needed (i.e. internal, external, onsite audits, Medicaid, PDE, etc.).

• Responsible for the Payer Information Management System Database File Maintenance.
• Understand the reimbursement process and how the data contained in these files can be used to support the process.
• Serve as point person in collecting and validating new insights from cross-functional team members on payer policies, requirements, and review process nuances.
• Act as a cross-functional liaison to understand and disseminate knowledge changes in payer policies/requirements/processes.
• Clean and update current system files.
• Receive payer notices and updates, load to payer database, and keep staff informed of payer changes.
• Notify necessary departments of changes and maintain a file of payer changes or notices for future reference.
• Create payer roadmaps to guide users to appropriate billing/PA/Appeal documentation and procedures.
• Assist Quality team in pulling necessary documentation for different types of audit requests and prepare presentations for client meetings.
• Educate staff on departmental policies and procedures, including maximizing first submission success.
• Serve as a Subject Matter Expert (SME) for operations to educate clients on best practices.
• Partner with client stakeholders to receive and share intelligence on payer trends and changes.
• Participate in Payer Focus Groups or other applicable meetings to share and identify payer nuances or trends.
• Provide insights or key learnings to internal and client stakeholders ongoing and as needed.
• Prepare and work with leadership to communicate updates to hub stakeholders.

Qualifications

• 5+ years of professional work experience required.
• Payer experience with a specific background in healthcare reimbursement, PBM, or hospital setting strongly preferred.
• 3+ years of MS Office experience.

Requirements

• Background in Health Care or Reimbursement with 1-3 years auditing and quality assurance work experience preferred.
• Knowledge of insurance plans including government payers, i.e., Medicaid, Medicare, and Tricare.
• Organizes work assignments, sets priorities, and completes work with minimum supervision.
• Knowledge and skills to understand insurance benefits including prior authorization and appeal process.
• Experience in medical terminology - 1-3 years related industry experience and/or training; or equivalent combination of education and experience.
• Demonstrated leadership capabilities.
• Ability to handle multiple tasks simultaneously and prioritize accordingly.
• Proven ability to work with a high degree of accuracy and attention to detail.
• Demonstrates core competencies of attention to detail, organization skills, ability to prioritize and follow up, effective communication, and ownership for one’s work.
• Proficient in Excel, Access, Word, and PowerPoint.
• Strong written and verbal communication skills, including the ability to interact with internal/external business partners in person or by phone.
• Able to work effectively with other internal/external functional departments.

Benefits

• Remote opportunities.
• Competitive salaries.
• Growth opportunities for promotion.
• 401K with company match.
• Tuition reimbursement.
• Flexible work environment.
• Discretionary PTO (Paid Time Off).
• Paid Holidays.
• Employee assistance programs.
• Medical, Dental, and vision coverage.
• HSA/FSA.
• Telemedicine (Virtual doctor appointments).
• Wellness program.
• Adoption assistance.
• Short term disability.
• Long term disability.
• Life insurance.
• Discount programs.

Company Description

UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, equitable and inclusive culture that fosters respect for each other, our clients, and our patients.