Insurance Payer Specialist

Job Description

Job Description

Work Location : Sunnyvale, CA

Pay Range : $30 / hr-$40 / hr based on experience

Job Type : Full-Time Onsite

Our Company :

Founded in 2010, iHealth is dedicated to empowering people to live healthier lives. The company is a leader in designing and manufacturing consumer-friendly, mobile personal healthcare products connected through the cloud that allows consumers to easily measure, track, and share vital health information with their doctors.

With a focus on delivering high-quality and accessible products, iHealth is at the forefront of the digital health revolution.

In 2018, iHealth established the Unified Care program to address the issue of managing chronic diseases. iHealth Care specialists support patients beyond the doctor’s office with chronic conditions via Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) to achieve better health outcomes.

In November 2021, iHealth's COVID-19 Antigen Rapid Test received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for over-the-counter sales.

Since then, iHealth has emerged as a key supplier of at-home COVID tests to the federal government, state governments, nonprofits, and individual consumers.

With its commitment to helping people lead healthier lives, iHealth is poised to continue driving positive change in the healthcare industry.

Summary :

This position performs complete health insurance payer analysis with respect to medical billing and reimbursement functions and is responsible for all aspects of payer research, communicate and manage complex payer and industry changes that impact the iHealth’s revenue cycle for Remote Patient monitoring, Chronic care management and Medical Nutrition Therapy services and its operations or strategies.

Duties and Responsibilities :

Perform health insurance payer analysis respect to medical billing and reimbursement functions

Explore and update key healthcare industry payers trends at both macro and micro levels

Define payer policies, coverages, pay rates for procedures,

Update internal and external stakeholders with policy changes in a timely manner

Annually updates insurance payment rates for each CPT / HCPCS code.

Execute on the implementation of assigned projects or operational issue resolution

Meet tight deadlines in a time sensitive and resource constrained project environment

Build payer coverage dashboard with payer benefits and PFS rate

Advancing payer relationships by keeping up to date with payer policy changes

Follow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO / PPO, etc.

Engage in end-to-end revenue cycle management process, including Eligibility verification, Authorization, charge entry, claim submission (including 837's and 1500 forms), payment posting, and accounts receivable management and extract reports from billing software

Understanding the EOB & ERA

Engage in follow-ups with insurance companies and medical groups to address denials and payer coverage issues

Develop, implement, and execute departmental procedures and processes

Generate reimbursements and analyze the revenue data to report trends related to errors & denials

Strong data mining skill to identify trends, areas for improvement, and opportunities for revenue growth

Analyze and identify opportunities to optimize revenue capture and reduce revenue leakage

Ensure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to ensure accurate and compliant billing practices

Conduct detailed data audits and clean-up as scheduled and as needed

Conduct payer coverage training for internal stakeholders and maintain adequate documentation of meeting

Implement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience for customers

Collaborate with IT teams to implement technology enhancements that improve billing & revenue efficiency

Maintain organized documentation of all billing and invoicing activities

Sending out invoices and maintaining a tracking system of incoming and late payments

Collaborates with internal teams, supporting the efforts and needs of other departments by providing assistance in a team-oriented approach

Maintain compliance with HIPAA(Health Insurance Portability and Accountability Act of 1996)

Must be a gatekeeper of the payer research and knowledge gained

Perform other related duties as required or requested

Minimum Qualifications

Bachelor's degree in accounting, health care administration, finance, business, or related field, with 5+ years of experience in an office environment or healthcare-related field

Knowledge of CPT / ICD-10 / HCPCS codes and EHR systems

Proficient in medical terminology and insurance plans

Experience with process improvement, quality control, data analysis and / or reporting

Integrity and respect for confidentiality and privacy

Attention to detail and the ability to work with a variety of databases

Leadership skills, including presenting and representing Payer Knowledge both internally and externally

Demonstrates the ability to work independently, is self-motivated, and self-directed with excellent verbal and written communication and documentation skills

Demonstrates strong organizational and time management skills, enabling effective prioritization of workflow to meet client requirements.

Possesses excellent customer service skills to ensure client satisfaction.

Ability to analyze problems and devise strategic solutions

Strong computer literacy with using Google Docs, Sheets, Slides and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)

Equal Opportunity Statement

iHealth Labs is committed to diversity in its workforce and is proud to be an equal opportunity employer. iHealth Labs considers qualified applicants without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, marital status, pregnancy, sex, gender expression or identity, sexual orientation, citizenship, or any other legally protected class.

iHealthLabs is an Affirmative Action and Equal Opportunity Employer.

Please reference below for more information : https : / / www.eeoc.gov / sites / default / files / 2023 -06 / 22- 088 EEOC KnowYourRights6.

12ScreenRdr.pdf and https : / / www.dol.gov / ofccp / regs / compliance / posters / pdf / OFCCP EEO Supplement Final JRF QA 508c.pdf