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    Insurance Payer Specialist - Sunnyvale, United States - IntelliPro Group Inc.

    IntelliPro Group Inc.
    IntelliPro Group Inc. Sunnyvale, United States

    1 week ago

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    Description

    Job Description

    Job Title: Insurance Payer Specialist

    Company: IntelliPro

    Position Type: Full-time/Contract

    Location: Sunnyvale, CA

    Salary Range: Open

    Duties and Responsibilities:

    • Perform analysis on health insurance payers related to medical billing and reimbursement functions
    • Research and update key trends in healthcare industry payers at various levels
    • Define policies, coverages, and pay rates for medical procedures
    • Communicate policy changes promptly to relevant parties
    • Annually review and update insurance payment rates per CPT/HCPCS code
    • Execute assigned projects and resolve operational issues
    • Adhere to deadlines in a fast-paced and resource-limited project environment
    • Create a dashboard of payer coverage details including benefits and PFS rate
    • Enhance payer relationships by staying informed about policy changes
    • Ensure compliance with regulations set by healthcare entities such as Medicare, State programs, and HMO/PPO

    Job Requirements:

    • Bachelor's degree in accounting, health care administration, finance, business, or related field, with at least 5 years of experience in an office or healthcare-related environment
    • Proficiency in CPT/ICD-10/HCPCS codes and EHR systems
    • Knowledge of medical terminology and insurance plans
    • Experience in process improvement, quality control, data analysis, and reporting
    • Great attention to detail and ability to work with different databases
    • Leadership skills, with the ability to present and represent Payer Knowledge internally and externally
    • Strong organizational, time management, and customer service skills
    • Problem-solving ability and strategic thinking skills
    • Computer literacy in Google Docs, Sheets, Slides, and Microsoft Office Suite

    About Us:

    Established in 2009, IntelliPro is a leading global provider of talent acquisition and HR solutions. Our dedication to exceptional service, employee development, and long-term partnerships distinguishes us. With a strong presence in various countries worldwide, we lead the global talent solutions industry.

    IntelliPro, a prominent connector of individuals with rewarding job opportunities, is committed to understanding your career goals. As an Equal Opportunity Employer, IntelliPro values diversity and inclusivity. We do not discriminate based on various factors and believe in embracing candidates of all backgrounds and abilities. Learn more about our inclusive practices on our website.

    Compensation: The salary for this role will be determined based on factors like education, experience, location, certifications, and more. Additionally, IntelliPro offers a comprehensive benefits package, subject to eligibility.

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