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VRI Payor Relations Specialist in Remote, United States

The Payor Relations Specialist, as part of the Revenue Cycle Management (RCM) department of VRI, is an integral contributor to the revenue cycle process. A successful Payor Relations Specialist understands the details of VRI’s product and service offerings and supports the business in performance to customers and clients by assisting with the initial Payor contract review, Payor onboarding, and the ongoing maintenance of the Payor’s billing requirements in the billing system. The position requires in-depth understanding of VRI contracts to ensure billing compliance thereby avoiding fee, refund, or damage payments to customers due to billing mistakes. It also protects revenue by promoting billing completeness and timeliness.

  • Maintain communication with Payors regarding changes to rates, policies, and procedures by phone, email and fax

  • Coordinate with Sales and Contract Management to review potential Payor contracts for ability to comply with stated billing requirements. Additionally, work with Sales and IT to onboard a new Payor to the billing system

  • Set up Payor accounts in the billing system in compliance with the VRI contract with the Payor and the Payor’s specific billing requirements

  • Update billing requirements for Payors in the billing system as changes are communicated and in a timely fashion

  • Work with the RCM Denial team to identify trends in denials by payor

  • Examine denials resulting from non-compliance to Payor billing requirements, work with the Payor to find a resolution, and implement the correction so future claims may be submitted successfully

  • Support the development of payor dashboards and payor performance metrics

  • Propose process improvements to address repeat data issues or trends

  • Manage incoming requests for assistance by responding to phone calls, emails, and faxes

  • Communicate with other VRI employees and teams by email, phone, and internal system notes and messages

  • Resolve problems by clarifying issues and applying standard operating procedures; research solutions and escalate items requiring attention from the Revenue Cycle Management leadership team

  • Apply knowledge of insurance billing information including modifiers, authorization criteria, CPT, ICD-10 coding and payor specific requirements

  • Comply with requirements to protect client data, use client data only for the purpose of managing the client’s account with VRI and associated claims, and follow all mandates in the VRI policies pertaining to HIPAA and PII

  • Utilize and comply with VRI and department policies, procedures, job aids, reference materials, memos, notes, videos and other trainings provided

  • Meet individual, team and department goals for productivity and quality

  • Other duties as assigned

  • High School Diploma or GED and 2+ years relevant medical claims and billing experience required; Degree in Healthcare or Business Administration preferred

  • Ability to manage, evaluate, understand, and act on analysis of large datasets

  • Proficient in the use of the internet, Microsoft Office suite of applications, billing systems and business intelligence reporting tools (Power BI, DOMO)

  • Self-motivated and comfortable managing multiple tasks at the same time

  • Team player with positive attitude and good communication skills

Job ID: 2021-1234

External Company Name: Valued Relationships, Inc.

External Company URL: https://www.vricares.com/