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IT Manager Payor Requirements - REMOTE/Revenue Cycle Mgmt

Company: CyberCoders
Location: Santa Ana
Posted on: February 20, 2021

Job Description:

We are an established growing organization looking for an IT Manager Payor Requirements to join our team, this is a REMOTE position. This is an IT position in our Revenue Management Systems & Informatics area. In this role you will become the SME and liaison between the technology team and the Revenue Management functional area.

You must have experience with Payor and Provider healthcare insurance, EDI and Medicaid and Medicare knowledge across different states.

The IT Manager Payor Requirements that will be system setup expert in insurance setup, mappings, clean claim requirements and act as liaison between our team and RCM departments. This individual will be on top of payor requirements and make sure communication is aligned across all lanes.

What You Will Be Doing

  • Knowledge of insurance guidelines including Medicare, Medicaid, HMO/PPO and other payor requirements and systems
  • Track and maintain carrier to payor mappings by region. Create a list of key billing requirements such as 2310A suppressions; state Medicaid requirements; HMO plans. Maintain electronic copies of payor manuals highlighting any changes to claim submission and audit new insurance translations in the billing system.
  • Act as a liaison between System Setup and RCM team when payor specific issues arise. As well as identify possible problem payors via denial trends that might result in submission changes
  • Review insurance masters provided from sites during integration to ensure carrier to payor alignment as well as any specific requirements are captured during integration/discovery phase
  • Work with all business owners to validate, approve payor specific requirements as well as educate about any exceptional payor requirements
  • Communicate payor requirement changes to all areas impacted and make sure it is documented via SNOW
  • Assist in development of contract strategies
  • Knowledge of best practices in RCM
  • Continuous improvement mindset and involvement in industry payor requirement changes
  • Audit to insure proper billing system setup payor to carrier mappings and educate team on setup
    What You Need for this Position
    • 5+ years of experience in similar role
    • 3-5 years of analytical experience, problem solving, root cause analysis skills
    • Intermediate Excel, SQL, and other database programs
    • 5+ years of experience with billing system set up preferred
    • Excellent verbal and written communication skills
    • Process Improvement and/or lean experience preferred
    • Experience working with health care data and performing comprehensive drill-down analyses from both a clinical and/or business perspective within the managed care environment
    • Excellent analytical and problem solving skills, across people, process and technology
      What's In It for You

      We the opportunity to be REMOTE and shine as this team grows!!

      So, if you are an IT Manager Payor Requirements with experience, please apply today!

      Email Your Resume In Word To

      Looking forward to receiving your resume through our website and going over the position with you. Clicking apply is the best way to apply, but you may also:

      • Please do NOT change the email subject line in any way. You must keep the JobID: linkedin : RK3- -- in the email subject line for your application to be considered.***
        Rhona Kannon - Principal Director - CyberCoders

        Applicants must be authorized to work in the U.S.

        CyberCoders, Inc is proud to be an Equal Opportunity Employer

        All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by law.

        Your Right to Work - In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Keywords: CyberCoders, Santa Ana , IT Manager Payor Requirements - REMOTE/Revenue Cycle Mgmt, Executive , Santa Ana, California

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