Billing Payor Analyst

Huntsville, AL

The Payor Analyst will review, research, and trend payor policies related to medical necessity, billing, and reimbursement. This includes pricing, coding, products, etc. for all contracted and non-contracted payers including commercial, Medicare, and Medicaid. The Payor Analyst will deliver trends and education to various teams within the organization as well client notifications. This position will report to the Director of Revenue Cycle Management.


Essential Duties and Responsibilities:

  • Understand payor contracts, state/national guidelines, and contract management system as appropriate
  • Review patient medical record and payer medical policies to determine validity of denials.
  • Obtain accurate understanding of the contract language, billing requirements, and fee schedules
  • Work with Contracting to resolve issues, clarify contract terms, etc
  • Audit contract terms that are loaded by the SIMs team for accuracy and expected revenue
  • Includes but not limited to service codes/products, standard rates, expected rates, rounding, and effective dates
  • Recognize and recommend changes as needed based on the contract and system configuration
  • Recognize and report payer trends to Management and Client.
  • Create detailed spreadsheets as requested by Management.
  • Complete payer projects as requested by Client or Management.
  • Research payer medical policies and insurance plan types to ensure up-to-date information is on file
  • Review case history, payer history, and state requirements to determine verbal challenge and appeal strategy
  • Gather and fill out all special appeal or review forms.
  • Create appeal letters, attach the materials
  • Participate in team and appeal meetings
  • Provide excellent customer service
  • Evaluates data, reports, feedback, observations, and other information in determining priorities
  • Uses prior knowledge and industry specific, historical experiences in resolving problems
  • Relies on instructions and pre-established guidelines to perform the functions of the job
  • Uses professional communication and conflict resolution techniques as required
  • References and reflects upon the Company mission, values, and strategic imperatives in completing and/or assigning all work
  • A certain degree of creativity and latitude is required
  • Conducts all assignments as a professional and role model with a sense of urgency
  • Other duties as assigned by Billing Department Director


Qualifications

  • Minimum of eight (8) years health insurance billing experience/payor policies
  • Associate Degree preferred but will consider experience
  • Coding Certification a must (AAPC or AHIMA)
  • Knowledge of payor contracting
  • Basic understanding of medical billing concepts
  • Extensive knowledge of Medicare, Medicaid, and Payer specific guidelines is preferred
  • Knowledge of medical terminology
  • Familiarity with HIPAA privacy requirements


Requirements

  • Ability to work independently with little supervision
  • General knowledge of healthcare contract modeling
  • Must be able to create and deliver educational findings to Sales, Senior Leadership, Billing Team, and Clients when necessary
  • Must be multi-tasked oriented
  • Microsoft Office Suite experience (Word, Excel, PowerPoint, Teams) a must
  • Proficient in using Microsoft Excel, Pivot tables, Teams, PowerPoint, and Word
  • XIFIN Laboratory Billing system experience preferred
  • Laboratory payor experience preferred
  • Must be able to always adhere to confidentiality standards and professional boundaries
  • Attention to detail a must
  • Time Management a must
  • Ability to remain calm and professional in stressful situations
  • Strong commitment to excellence
  • Possess excellent written and verbal communication skills
  • Well-developed problem-solving/analytical skills
  • Experience utilizing Payer Web Portals
  • Experience reviewing medical records and knowledge of medical terms
  • Quick-thinking and astute decision-making skills
  • Excellent organization and communication skills


Additional Information

Monday- Friday 7:30am - 5:30pm CST

  • Excellent full time benefits including comprehensive medical coverage, dental, and vision options
  • Life and disability insurance
  • 401(k) with company match
  • Paid vacation and holidays


Eurofins is a M/F, Disabled, and Veteran Equal Employment Opportunity and Affirmative Action employer.


Eurofins Scientific is an international life sciences company, providing a unique range of analytical testing services to clients across multiple industries, to make life and our environment safer, healthier and more sustainable. From the food you eat, to the water you drink, to the medicines you rely on, Eurofins laboratories work with the biggest companies in the world to ensure the products they supply are safe, their ingredients are authentic and labelling is accurate.


The Eurofins network of companies is the global leader in food, environment, pharmaceutical and cosmetic product testing and in agroscience Contract Research Organisation services. It is one of the market leaders in certain testing and laboratory services for genomics, discovery pharmacology, forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global presence in Contract Development and Manufacturing Organisations. It also has a rapidly developing presence in highly specialised and molecular clinical diagnostic testing and in-vitro diagnostic products.


In over 30 years, Eurofins has grown from one laboratory in Nantes, France to 58,000 staff across a decentralised and entrepreneurial network of 900 laboratories in over 54 countries. Eurofins companies offer a portfolio of over 200,000 analytical methods to evaluate the safety, identity, composition, authenticity, origin, traceability and purity of biological substances and products.


In 2021, Eurofins generated total revenues of EUR 6.72 billion, and has been among the best performing stocks in Europe over the past 20 years.


Eurofins is a M/F, Disabled, and Veteran Equal Employment Opportunity and Affirmative Action employer.

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