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Coding and Payer Policy Specialist

Physicians Resources LTD
Merrimack, NH
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Coding and Payer Policy Specialist

You are a driven achiever who loves personal and professional challenges. You thrive on solving complex problems and interacting with customers and coworkers. You are calm under pressure and manage the details of multiple, time-sensitive projects with competing priorities, without breaking a sweat.

You have a passion for tackling challenging problems and being part of something bigger than yourself. Healthcare billing is a complicated, ever-changing environment, full of barriers. Healthcare providers and their staff depend on us for their livelihood and so it is up to us to overcome those barriers. Are you up for the challenge of helping to improve this crucial industry?

Company Overview

PRL is a fast-growing Revenue Cycle Management (RCM) company that leverages automation and technology to provide industry-leading billing services to healthcare provider organizations. Our systems use smart technology to automate workflow, improve charge capture, manage code compliance, and provide custom rules for intelligent claims review. By leveraging the best RCM technology, we are able to integrate our RCM solutions into our clients’ ecosystems. 

Not only do we strive to provide the highest level of personalized service, but we understand the importance of relationships. These relationships translate into the work we do, the people we meet, and the communities we serve. Each day we innovate, collaborate, and solve problems for our clients, improving the way physician practices and health systems operate today. We strive to empower our people through career development, service opportunities, and a supportive community so they can reach their fullest potential. Here at PRL, our people come first.

Position Summary

Reporting to the Director of Coding, Compliance, and Education, the Payer Policy Specialist will ensure outstanding customer service and client satisfaction and be responsible for the overall level of service and quality while ensuring financial performance objectives are met. The incumbent will provide planning, direction, and client support to ensure strategic goals and key performance indicators are achieved.  Client satisfaction is vital to our long-term viability and profitability. Our success is dependent on our clients receiving massive value from our service. The role includes responsibilities for customer success, on boarding, support services, service adoption and improvement, retention, and outcomes.

 Responsibilities include but are not limited to:

  • Research and identify changes in medical and reimbursement policies for existing and prospective services/products
  • Navigate through payer websites, portals, newsletters, and other applicable avenues as a means to identify changes in healthcare affecting revenue cycle
  • Maintain and create new payer guideline policies and documents for internal and external use
  • Communicate proactively with members of the revenue cycle team and external customers on changes that affect procedures and existing policies.
  • Advise the revenue cycle management team on emerging trends and methodologies, payer relations and other shifting payer reimbursement trends to facilitate ongoing compliance with payer requirements
  • Inform and educate revenue cycle staff and external customers on health plan policies and procedures to correct operational deficiencies and ensure compliance and ongoing revenue enhancement
  • Act as a resource, to understand the payer and reimbursement relationships that affect our revenue cycle business performance
  • Maintain knowledge of all services provided and insurance requirements for new and emerging procedures and medical technology
  • Participate in monthly/quarterly payer meetings, in-services, education and training to address and resolve issues
  • Develop and manage favorable relationships with new and existing clients.
  • Responds to customer concerns to ensure highest level of satisfaction
  • Identify opportunities for continuous improvement
  • Learn from best practices in industry
  • Asks questions to gain understanding of each function's contributions to the organization.
  • Creates an environment for “Client First” at all levels of the organization.
  • Foster culture of customer success 

Requirements/Qualifications

  • Bachelor's Degree or equivalent work experience. 
  • 20 hours of industry specific continuing education annually.
  • CPC certification from recognized governing association (i.e. AAPC, AHIMA) preferred
  • In depth knowledge of medical terminology, CPT and ICD.10
  • Minimum 4 years’ experience in a healthcare setting 
  • Ability to work independently, communicate proactively, manage multiple projects, and prioritize daily tasks while managing critical deadlines
  • Ability to develop and utilize cross-functional relationships to facilitate the accomplishment of work goals and objectives
  • Excellent overall oral and written communication skills
  • Strong analytical and interpersonal skills within all levels of the organization
  • Proficiency in Outlook, Word, and Excel
  • Demonstrated knowledge base and experience with third party reimbursement
  • Proven ability to think innovatively and apply best practices in an organization.
  • Ability to make decisions accurately and decisively.

Our Commitment to Diversity and Inclusion 

A culture of innovation, diversity and inclusion is the PRL way. Equality drives our spirit and fuels our creativity. We celebrate, value, and appreciate all voices and are continually building a culture where everyone has the freedom to be their authentic self. Our commitment to inclusion across race, color, religion, gender identity, sexual orientation, disability, age, veteran status, and experience drives our success and makes our company stronger.

Physicians Resources LTD

Address

Merrimack, NH
03054 USA

Industry

Healthcare

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