The Payer Contract Specialist is responsible for understanding insurance contracts, reviewing underpayments, identifying trends in payment discrepancies amongst payers, and other assigned duties listed in requirements.
· Reviewing underpayments to determine if additional payment amounts can be requested
· Understanding insurance contract terms
· Ability to present ideas on complex, detailed issues with ease
· Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
· Identifying trends in payment discrepancies amongst payers
· Auditing closed balance and write-off claims to ensure accuracy of payment to contract
· Working with contract management to identify opportunities when negotiating contracts with payers
· Understands payer determination, contract fees, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization, eligibility, etc.
· Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
· Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
· Experience working with ICD-9, CPT-4 and/or HCPCS coding systems
· Knowledge of insurance submittal procedures and medical forms (including UB04 and CMS1500)
· Performs other duties, as assigned.