Description
Summary/Objective
The Payor Analyst is responsible for completing complex appeals, refund audits, and payor projects.
Essential Functions
- Assist in resolving denied, scrubbed, or held claims by investigating rejected claims, utilizing provider websites or phone conversations to determine corrective actions
- Maintain appropriate documentation and files regarding all patient account interactions in the Revenue Cycle Management System.
- Field questions from co-workers and staff as required.
- Actively participate in facility and departmental communication through daily review of email messages.
- Review claim documentation and correct coding when necessary.
- Recognize and research trending claim denials.
- Stay updated on specific billing requirements to ensure appropriate claims processing and reimbursement.
- Perform any other duties as assigned by the manager.
Competencies
- Strong people skills with a warm and friendly demeanor.
- Strong organizational skills and proficiency in basic office operations to ensure appropriate documentation and follow-through.
- Proficient computer skills, including accurate data entry into Microsoft Office software and basic internet usage.
- Knowledge and/or willingness to understand insurance guidelines and requirements.
- Current knowledge of CPT/ICD10/HCPCS usage.
- Ability to review documentation to obtain basic procedural and/or diagnosis codes.
Supervisory Responsibility
This position does not have supervisory responsibilities.
Work Environment
This job operates in a professional medical office environment, utilizing standard office equipment.
Physical Demands
The physical demands include standing, walking, and occasionally lifting or moving up to 25 pounds.
Position Type/Expected Hours of Work
This is a full-time position, with an 8-hour shift Monday through Friday. No weekends are required.
Travel
No travel is expected for this position.
AAP/EEO Statement
US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities vary dependent on job location.
Requirements
Education and Experience
- High School Diploma or GED Equivalent
- Minimum of 2-3 years of experience in a medical or office setting.
- Experience with EMR systems is preferred.
Work Authorization/Security Clearance
Must be authorized to work in the US for any employer
Skills Required
- High School Diploma or GED Equivalent
- Minimum 2-3 years of experience in a medical or office setting
- Authorized to work in the US for any employer
- Proficient computer skills, including Microsoft Office and basic internet usage
- Current knowledge of CPT, ICD-10, and HCPCS coding
- Ability to review documentation to obtain basic procedural and diagnosis codes
- Experience investigating denied claims, completing appeals, and refund audits
- Experience with EMR systems
- Strong organizational and interpersonal skills
What We Do
U.S. Digestive Health is a physician-led, professionally managed Management Services Organization (MSO) specializing in gastroenterology across Pennsylvania and Delaware. It supports physicians by managing backend operations, finance, and administrative functions, allowing them to focus on patient care. The organization operates a network of over 40 locations and 24 ambulatory surgery centers, aiming to redefine digestive medicine through technological advancements and research.
