Analyst, Payer Accountability

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. 

As our Analyst, Payer Accountability, you will help the Billing Department understand and navigate payer guidelines. Every day you will research and interpret contract terms and Identify and escalate claim issues with payors and external or internal stakeholders. To thrive in this role, you will understand basic concepts of hospital/physician billing principles, the ability to navigate payor guidelines, the ability to analyze, formulate, and initiate actions to resolve claims/issues, and the overall escalation of claim issues with payors when necessary.

Here’s what you will experience working as an Analyst, Payer Accountability:

• Understand and navigate payor guidelines (portals, manuals, contracts, etc.)

• Research and interpret contract terms along with compiling necessary supporting documentation to obtain resolution of outstanding AR.

• Identify and escalate claim issues with payors and external or internal stakeholders, when appropriate.

• Analyze data for identification and monitoring of payer trends, managed care / contract compliance, and operational processes specific to R1 and the respective client being serviced.

• Follow payer specific guidelines for escalated claim(s) submission.

• Work closely with leadership to optimize payer performance and resolve escalated issues efficiently

• Collaborate with various departments/teams to handle escalated issues and prevent future escalations where possible.

• Provide feedback to global partners/clients, fellow associates, and other impacted departments, as applicable.

• Identify and review the root cause of escalation(s) to improve AR collections and escalation procedures.

• Support internal and external customers by responding to and managing complaints and escalations. 

• Solve moderately complex problems and time sensitive inquiries.

• Decipher payer specific escalation files with payer responses and determine next steps for achieve resolution.

Required Skills:

• Self-motivator with ability to work in remote environment with minimal supervision

• Analytical and problem solving/critical thinking skills

• Excellent working knowledge of Revenue Cycle Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors

• Proficient in Microsoft Office Suite (Word, Excel, and Outlook)

• Ability to implement process improvements based on the directives of leadership.

• Ability to multi-task and manage various demanding assignments that at times may conflict.

• Ability to independently troubleshoot system challenges for resolution.

• Proficient written and verbal communication skills