Lead Analyst, Payor Relations

Job Type Full-time Description Job Title: Lead Analyst, Payor Relations Job Type: Full-Time Location : Hybrid, requiring 2 to 3 days in the office SUMMARY : As the Lead Analyst, Payor Relations, you will oversee and manage our payer relations team, focusing on Independent Dispute Resolution (IDR), contracts, and the accurate processing of over and underpayments, as well as management of Paylocity edits and approvals. Your role will be crucial in maintaining and enhancing our relationships with payers, ensuring compliance with contractual obligations, and refining our financial procedures to optimize revenue cycles. Duties include but are not limited to: Independent Dispute Resolution (IDR) Lead the team in managing and resolving payer-related disputes, ensuring timely and effective resolution. Monitor IDR processes and outcomes, providing regular updates to senior management. Develop and implement strategies to streamline IDR workflows, reducing resolution times. Ensure compliance with regulatory requirements and payer guidelines. Contracts Management Assist with oversee the negotiation, execution, and management of payer contracts. Ensure all contract terms are met and maintain accurate records of contract details. Regularly review and update contracts to reflect changing regulations and organizational needs. Help Manager to develop metrics to evaluate contract performance and adherence to terms. Over and Underpayments Lead the team in identifying, analyzing, and resolving over and underpayments from payers. Assist Manager to establish and monitor key performance indicators (KPIs) to track over and underpayment resolution rates. Help Manager implement procedures to minimize future discrepancies and improve payment accuracy. Provide detailed reports on payment discrepancies and resolution efforts to senior management. Metrics and Performance Indicators IDR Resolution Time: Track the average time taken to resolve disputes. Contract Compliance Rate: Measure the percentage of contracts fully compliant with terms and regulations. Over and Underpayment Resolution Rate: Monitor the rate at which payment discrepancies are identified and resolved. Accuracy of Payments: Calculate the percentage of payments processed without discrepancies. Team Efficiency: Assess the productivity and efficiency of the payer relations team in handling assigned tasks. Requirements MINIMUM QUALIFICATIONS To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education: High School Diploma or equivalent required. An associate degree or medical billing education preferred. Experience: Three (3) years of customer service experience in a medical billing environment is required. Two (2) years of medical Accounts Receivable and the ability to understand and analyze complex AR resolutions is highly preferred. Leadership Abilities: The desire and drive to help lead a team of individuals while also being open to direction and instruction received from supervisor or above. Language Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences. Computer Skills: Experience with medical billing software systems is preferable along with Microsoft Excel, Microsoft Outlook, Word, and PowerPoint proficiency. Reasoning Ability: Ability to organize and manage personal workload and the workload of assigned direct reports and associated teams. Ability to achieve and maintain strong working knowledge of anesthesia billing operation practices. Ability to analyze and assess the production effort of operations teams. Ability to work within an ambiguous, fast-moving environment, while driving toward clarity and solutions. PHYSICAL DEMANDS AND WORK ENVIRONMENT The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, stand, walk, use hands to finger, handle, or feel, reach with hands and arms, and talk or hear. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally be able to work in a standing position for short periods of time. About Providence Anesthesiology Associates Headquartered in Charlotte, North Carolina, Providence Anesthesiology Associates (PAA) is an independent physician owned practice compromised of over 140 anesthesiologists. Founded in 1991, PAA provides anesthesia and perioperative care at numerous healthcare facilities throughout North and South Carolina, serving more than 232,000 patients annually. Why work for PAA? PAA continues to experience impressive growth and success. Our anesthesiologists are among the most elite in their field. Our physicians are committed to providing the best culture and experience to their employees. Awarded one of the Top Workplaces in , PAA's core values include commitment, accountability, performance, integrity, transparency, adaptability, and leadership. We do what's right and don't compromise. What's in it for you? Strong workplace culture. We care about each other as people. We build relationships and connections beyond the time spent on the job. We offer a supportive, highly team-oriented work environment. We provide competitive total rewards including salary, benefits - Day 1, retirement, profit sharing, life insurance, paid time off, holidays, education reimbursement, employee recognition for birthdays and anniversaries, fun team building events, and more. We want you to succeed and our employer to employee relationship is proven to help you reach your goals and the goals of PAA. What else should you know? Providence Anesthesiology Associates is an equal opportunity employer and does not tolerate discrimination based on any protected status. PAA participates in E-Verify. E-Verify is an internet-based system that compares the information you provide on the Form I-9 with information from the Social Security Administration and Department of Homeland Security records.

Created: 2024-11-05