Job Summary
The Senior PBS IDR Analyst will audit and review processes for benchmarks, identify deficiencies, document findings, use critical thinking and problem solving to provide analysis and determine opportunities to improve outcomes and/or processes. This role is responsible for knowing CMS NSA Guidelines and quickly adapt to the changes within the No Surprise Act. The PBS IDR Analyst will define problems, collect data, identify causal factors, identify root causes, and recommend and implement solutions. This position has analytical, and/or administrative responsibilities specific to the department. Responsible for being up to date on department processes and involves specialized background or knowledge regarding claims processing rules relevant to the assignment. This role will be the Subject Matter Expert within IDR Program and provides support and training to IDR Analysts.
Essential Functions and Responsibilities include the following:
- Conduct focused quality audits across various IDR functions to ensure quality standards, procedures, and methodologies are being followed. Documents findings of analysis and prepares recommendations for implantation of new systems, procedures, or organizational changes to reduce errors.
- Execute the IDR process for each dispute from initiation to completion. This includes, but not limited to submitting initiations, indexing, making fee payments, building offers, submitting offers, and updating tracker
- Review and audit IDR process, tracker and dashboard to ensure no data gaps to accurately gather, synthesize and communicate timely relevant information to ensure IDR process is performing without error.
- Compile data, provides feedback, monitors, and evaluates the implementation of corrective action plans, and generates reports for operations and/or training areas on quality performance
- Support and communicate with IDR leadership on quality escapes, improvement ideas and other components of the IDR process to maintain timely process
- Other duties as assigned
Additional Job Requirements
- Regular scheduled attendance
- Indicate the percentage of time spent traveling - 10%
Subject to applicable laws and Air Method’s policies, regular attendance is an essential function of the position. All employees must follow Air Methods’ employment practices and policies.
Supervisory Responsibilities
This position has no supervisory responsibilities.
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. In accordance with applicable laws, Air Methods will provide reasonable accommodations that do not create an undue burden so disabled employees may perform the essential functions of the position.
Education & Experience
- High School Diploma or general education degree (GED) and 5 to 8 years’ related experience and/or training; or equivalent combination of education and experience
- Bachelor’s degree (B.A. /B.S.) preferred.
- 5 - 8 years’ experience working with medical billing; claims, appeals, coding, cash posting, customer service, insurance verification, medical records
- 5 - 8 years of experience in healthcare financial and revenue cycle analysis preferred
Skills
- Strong analytical and organizational skills
- Excellent written communication skills
- Accuracy and Precision
- Ability to multi-task, critically think and prioritize workload in a fast-paced environment
- Working knowledge of healthcare payment models, revenue cycle, payer contracting, claims life cycle
- Ability to work with multiple departments and understand the processes and workflow for each
- Ability to work independently with minimal direction
- Ability to work closely with management and trainer to identify any training opportunities to remediate deficiencies found
- Ability to exercise discretion and judgment while auditing the work of others
Computer Skills
- Advanced in Microsoft Suite, including Word, Excel, PowerPoint, and Outlook.
Certificates, Licenses, Registrations
Air Methods is an EEO/AA employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
