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Payer Relations Specialist

Description:

RESPONSIBLE FOR:
This position is the liaison between payers and all impacted stakeholders within the Piedmont organization, is responsible for providing expert knowledge and project management of the payer escalation workflow, including, workbooks, work queues & meetings. This person will provide, as needed, impact analysis of issues and up-to-date information of payer rules and regulations. As part of the payer relations workflow, the Specialist will aid in identifying areas/processes needing improvement to ensure optimal reimbursement within regulatory requirements. This role provides direction and support, related to payer issues and processes, and collaborates with leadership.

Qualifications:

MINIMUM EDUCATION REQUIRED:
Bachelor's degree is required.

MINIMUM EXPERIENCE REQUIRED:
One (1) year of related revenue cycle experience.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Healthcare Business Insights (HBI) Patient Financial Services Specialist certification or equivalent.

ADDITIONAL QUALIFICATIONS:
Third-party experience with government, commercial, and managed care payers
Knowledge of insurance contracts
Experience with payer reimbursement methodologies (Commercial and Government) preferred
Previous Epic experience preferred

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