Paddock Lake, WI
This position reports directly to the Payor Analyst Lead, Revenue Cycle Management and is responsible for financial results of the payors. In addition, this role is, responsible for following policies, procedures and systems for quality assurance as directed by Medicare, Medicaid and Private insurance.
Highly motivated Payor Analyst in billing, claims, denials and document management to work with our internal and external customers on the phone, via software applications and via email.
• Responsible for understanding all general rules, guidelines, and methods to get paid from the payors that they are responsible for
• Responsible for the financial results of the Payors
• Responsible for preventing Credit Adjustments / Write Off’s for the Payors
• Responsible for AR / Denial from multiple sources of payors & customers
• Payor Specific AR / Denial Guides are updated with the most current information
• Communicate required updates in the SharePoint/Fluency system
• Propose changes / updates to Brightree Price tables and Payors to prevent denials and credit adjustments / write off’s and minimize reworking invoices
• Notify Teams of all updates / changes to documentation
• Implements and adhere to policies, procedures and systems within the Brightree systems
• Ensures accuracy to optimize reimbursement while adhering to regulations.
• Prepares and submits reports to team lead as needed
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals
• Maintains patient confidentiality and function within the guidelines of HIPAA
• Other tasks and responsibilities as assigned.
• High School degree required; college coursework a plus
• A minimum of health care billing or customer service experience is a plus
• Knowledgeable of federal and state laws and requirements relating to healthcare management.
• Computer literate and proficient in using MS office programs
• Equivalent combination of education and experience will be considered
Suna Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.