What are the responsibilities and job description for the Payer Integrity Analyst position at Tennessee Orthopaedic Alliance?
Description
Tennessee Orthopaedic Alliance is the largest orthopedic surgery group in Nashville and Middle Tennessee. TOA concentrates on the diagnosis and treatment of disorders and injuries of the musculoskeletal system which allow our patients to live their best life. Ninety plus years later we are advancing the practice of orthopedic surgery throughout the state.
There are several reasons why TOA is an employer of choice; here are a few of them:
- Stability - TOA has been in Middle Tennessee since 1926 and has expanded to over 20 locations across the state!
- Impact - TOA's team members use our careers — whether in our clinics or our business office — to make a positive difference in the community by building relationships and helping patients live their best life.
- Work Environment - The TOA team focuses on fostering an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
- Total Rewards - TOA offers competitive salaries, plus a comprehensive suite of benefits, including Medical, Dental, Paid Time Off, and more. Our 401(k) plan provides a company match, safe harbor match and profit-sharing match to go along with your contributions.
Responsibilities
Among the Responsibilities for our Payer Integrity Analyst:
- Research payer underpayment/overpayment issues and follow-up with payers for resolution in an effective and timely manner.
- Research and identify payment discrepancies from various sources.
- Assist management with identifying payer discrepancies versus contract terms.
- Review payer policies for impact on reimbursement.
- Produce AdHoc reports to provide both detail and summary information regarding underpayment/overpayment, denial, and other payer trending issues.
- Provide recommendations based on evidence gathered from researching issues pertaining to payer claim allowances.
- Collaboratively work with financial and clinical departments.
- Identify payer to contract mapping issues and escalate to management for resolution.
- Identify contract calculation issues and escalate to management for resolution.
- Identity patterns of incorrect payer assignments during registration process and escalate to management for resolution.
- Other duties as assigned.
Requirements
Among the qualifications for our Payer Integrity Analyst:
- Highly organized
- Initiative to work independently.
- Proficient in analytical skills and reporting
- Must have the ability to define problems collects data, establish facts, and draw valid conclusions.
- Interest and aptitude in computer-based applications for complex business processes.
- Required PC competencies including intermediate Microsoft Office skills.
- Excellent interpersonal skills required to communicate with internal/external customers.
- Must possess excellent time management and organizational skills with great attention to detail.
- The ability to manage working on multiple projects/initiatives.
Education:
- High school and/or equivalent.
- 2 year of healthcare experience, preferably in an orthopedic group practice.
- Maintain any applicable continuing education requirements.
- Experian product knowledge is desirable.
TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers.
