Overview

Job Highlights

• Assist with documenting, developing, testing, loading and maintaining payer rules for the USAP Payer Contract Management system in Athena IDX
• Assist with maintaining all fee schedules and contracts within the Payer Contract Module
• Research and understand USAP payer contracts and payer reimbursement policies to ensure accurate payer rules loading
• Utilize the Term Failure Reports to assist with accurately resolve false variances caused by missing or incorrectly loaded terms
• Review invoices daily in the PCM queue sent to the Contract Management team for term review and work tasks as required
• Ability to demonstrate simple to complex rules writing and maintenance
• Assist with ensuring compliance with payer policy billing regulations and monitoring of changes
• Effectively communicate with internal compliance, payer relations, and revenue cycle management operations regarding applicable changes
• Other duties as assigned by management

Qualifications

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

• Healthcare revenue cycle management experience
• Anesthesia experience preferred
• Professional verbal and written communication skills
• Advanced Skills in Microsoft Excel.
• Basic knowledge of managed care programs and billing requirements necessary.
• Good mathematical skills a must
• Detail oriented with ability to drill into the details of specific claims as well as analysis and identification of trends in a larger set of claims
• Ability to work independently with limited supervision
• Understands anesthesia claims and associated medical coding, as well as having a working knowledge of internal registration and billing systems
• Strong analytical skills and ability to gather, analyze and report on information from multiple sources (i.e., Billing system, internet, payer contracts, etc.)
• Working knowledge of government programs and commercial compliance billing guidelines and reimbursement practices
• In-depth knowledge of financial class setup and payer setup within billing system preferred
• Knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals, and health insurance benefit plan designs
• Ability to handle sensitive and confidential information with professional discretion

EDUCATION/TRAINING/EXPERIENCE:

• High School diploma. Associate or bachelor’s degree in business administration or related field of study preferred.
• 3+ years of experience in a healthcare business office required. Collections and/or payment posting experience preferred
• Athena IDX experience is preferred
• Anesthesia billing knowledge

PHYSICAL REQUIREMENTS:

• Requires prolonged sitting, some bending, stooping, and stretching
• Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator, and other office equipment
• Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
• Requires dexterity to type at least 35 wpm.
• Ability to read, write, and speak English

WORKING CONDITIONS (environment and safety):

• Work performed in office environment or in remote office setting
• Involves frequent contact with professional staff and managed care organizations
• Work may be stressful at times
• Interaction with others is frequent and often disruptive

Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.