AbleNet, Inc. · 5 hours ago
Payer Excellence Analyst
United States
Full-time
Remote
Mid Level
$67K/yr - $75K/yr
3+ years expAbleNet, Inc. is seeking a Payer Excellence Analyst responsible for resolving denied claims cases. This role involves analyzing denied claims, adhering to federal regulations, and managing an inventory of files to achieve key performance indicators related to claims resolution.
Medical Device
Responsibilities
Analyze, research, correct, and resubmit denied or rejected claims for federal, state, and private insurance in accordance with established workflows and timelines
Follow the denial management framework 100% of the time
Perform daily file-level analytical work to drive claims toward resolution and reimbursement
Perform proactive follow-up, status checks, and payer outreach on unpaid or underpaid claims
Document all claim actions, outcomes, and communications accurately and timely
Monitor claim aging and prioritize work to ensure optimal resolution within the framework
Identify submission errors, payer trends, and recurring denial issues and report findings to leadership
Respond to internal and external inquiries related to claim status via phone, email, fax, or written correspondence
Coordinate with accounting and finance teams to resolve claim-related payment or reconciliation issues
Work collaboratively with all Payer Excellence team members to support team-level performance and workload alignment
Demonstrate the core medical department philosophies: Listen, Learn, and Lead
Incorporate the organization’s 7 rules of engagement into daily work
Complete final resolution of complaints, grievances, and appeals within established timelines
Assist as backup support for senior coordination functions, including casing mail, billing claims, and managing claims inboxes, as assigned
Adhere to all practice policies related to HIPAA and Medicare Compliance
Perform other duties as assigned by management
Qualification
Required
Bachelor's Degree required
3+ years of medical billing and/or claims processing/submission experience: general knowledge of industry forms and files, CPT and ICD10 coding knowledge and familiarity with medical terminology
Self-motivated with the ability to work independently and within a team environment
Strong analytical, problem-solving, and decision-making skills
Ability to manage volume-driven workloads in a metric-based environment
Strong attention to detail with consistent documentation practices
Excellent written and verbal communication skills
Ability to apply general rules to specific claim scenarios to produce accurate outcomes
Ability to multitask efficiently and accurately under pressure
Ability to adapt to a fast-changing environment
Proficient working knowledge of claims systems, Microsoft Office products, and supporting databases
Strong computer skills with the ability to learn new systems and claims platforms
Data entry and account management experience
Adhere to all practice policies related to HIPAA and Medicare Compliance
Preferred
Medical billing certification preferred
Company
AbleNet, Inc.
At AbleNet, we believe everyone deserves the tools to thrive.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Adam Wing
Chief Revenue Officer (CRO)
Company data provided by crunchbase