Payer Plan Coordinator

Job Description:

An hourly position responsible for reviewing and validating all incoming payer plan tickets, then, coordinating communications with appropriate teams to determine the overall impact of changes made to payer plans to ensure the successful billing of claims across all regions within the organization.

Essential Functions

• Hosts PPGC (Payer Plan Governance Committee) for all regions

• Brings new plan requests to the meeting for discussion/approval

• Communicates new plan creation issues

• Follows up with other teams take aways

• Responsible for timely processing of Payer Plan Service Desk tickets

• Obtains votes from PPGC

• Routes tickets to contract build, ITDS, and/or RCLD

• Network Status subject matter expert

• Know and understand how each payer/plan in Epic is utilized and how it applies to specific networks

• Collaborate with Managed Care to determine network status

• Hold quarterly meetings to update network status matrix

• Epic payer and plan subject matter expert

• Learn and understand the payers and plans built into Epic and how they are utilized, answer any questions on their use

• As the subject matter expert, candidate will be the primary contact for validation of information

• RTE mapping subject matter expert

• Ability to understand what is said in the RTE responses and how they mapped to which plan (or didn't) to the best of your ability.

• Works with Patient Access, ITDS on challenges with RTE

• Runs reports and communicates trends to appropriate teams

• Collaborates within the system on a regular basis to ensure all above items are running smoothly, not limited to following teams

• Revenue Cycle and Learning Development

• Contract Build

• Managed Care

• Finance

• Revenue Cycle

Skills

• Microsoft Office
• Computer literacy
• HIPAA regulations
• Communication (oral and written)
• Accountability/ability to work independently
• Contract Interpretation
• Customer Service
• Read and interpret EOB's (Explanation of Benefits).
• Knowledge of medical billing and collections
• Medical terminology
• Epic Experience

Qualifications

• High school diploma
• Must obtain CSPR or CRCR credentials within 1 year of hire date (provided through employer).
• Two (2)+ years of experience in hospital or physician insurance related activities (Billing & Follow-Up)
• Knowledge of revenue and ICD 10 coding practices

Physical Requirements

• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set-up and use.
• Expected to lift and utilize full range of movement to transport, pull, and push equipment. Will also work on hands and knees and bend to set-up, troubleshoot, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.
• Participate and lead special projects, as assigned. Oversee work flow implementation with internal and external partners. Compile and coordinate materials and feedback on special projects. Trains and mentors new associates to the department. Serves as a subject matter expert and resource to answer questions within the department.

Minimum Qualifications

• High School Diploma or equivalent, required

• Minimum of three (3) years of experience in revenue cycle insurance follow up or denial management, required

• Extensive knowledge of managed care contract interpretation, required

• Associate's Degree, preferred

• At least three (3) years of work experience in a complex invoice/billing/reconciliation environment, preferred

For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

The following states are currently paused for sourcing new candidates or for new relocation requests for current caregivers:

California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Washington.

Location:

Peaks Regional Office

Work City:

Broomfield

Work State:

Colorado

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$24.00 - $36.54

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.