Melville,NY - USA

Position Requirements

The Pod Captain, Payer Configuration Analyst, plays a critical leadership role within the Revenue Cycle Management (RCM) team, overseeing a dedicated group of Payer Configuration Analysts. This position is responsible for ensuring that our payer configurations within the Athena system are meticulously set up and maintained to drive accurate billing, compliance, and overall revenue integrity. As the lead on the team, the Pod Captain will guide and mentor analysts in configuring payer contracts, rules, and workflows within Athena to align with our organizational needs. This role involves a strategic focus on optimizing system settings to maximize reimbursement, minimize denials, and ensure that all payer-related configurations are fully compliant with contractual agreements and regulatory requirements. The Pod Captain will also be instrumental in developing and implementing best practices, ensuring that the team's work is consistent, efficient, and aligned with the company’s revenue goals.

PRIMARY RESPONSIBILITIES:

Payer Configuration Management

• Oversee the configuration and maintenance of payer contracts, rules, and workflows within the Athena system.
• Ensure accurate setup of payer-related parameters to optimize revenue capture and minimize errors.
• Coordinate with other departments to align payer configurations with organizational needs and regulatory requirements.

Team Leadership and Development

• Provide training and development opportunities to ensure the team’s continuous growth.
• Monitor team performance and productivity, ensuring high standards are maintained.
• Facilitate regular team meetings to discuss progress, challenges, and updates

Proactive Auditing and Issue Resolution

• Regularly audit allowables, collection reports, and system setups to identify discrepancies or issues that could impact financial modeling and revenue.
• Troubleshoot and resolve complex system configuration issues, working closely with IT and other stakeholders.
• Implement corrective actions and improvements based on audit findings

Reporting and Performance Analysis

• Generate and analyze reports on payer configurations, collection trends, and audit outcomes.
• Provide insights and recommendations to senior leadership based on data analysis.
• Track key performance indicators (KPIs) related to payer configuration and team performance, using this data to drive continuous improvement.

QUALIFICATIONS REQUIRED QUALIFICATIONS:

• Minimum of 4 years working with payers, health care analytics, system support, or Specialist experience in healthcare field.
• Interpersonal skills, willing to communicate effectively with the team.

DESIRED/PREFERRED QUALIFICATIONS :

• 3-5 plus years of experience with medical billing knowledge.
• Knowledge of payer contracting.
• Knowledge of understanding guidelines for Medicare/Medicaid, government plans, HMOs, and PPOs
• Strong computer skills (including MS Word and Excel).
• Has a strong working knowledge of billing procedures, insurance reimbursement and guidelines, preferably in a medical or anesthesia setting.
• Must be able to communicate effectively and professionally to insurance companies along with co-workers and management.

• Experience with other healthcare information systems or electronic health records (EHR) beyond Athena.
• Previous experience working within a large multi-state healthcare organization or within a specialty-specific RCM environment, such as anesthesia.

• Ability to perform at a high level of productivity and quality.
• Work in collaboration with the Manager to improve processes.
• Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance.
• Knowledge of anesthesia billing.

Total Rewards

• Salary: $53,800 - $73,976
• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities

This is a virtual position, but we prefer candidates to be based in one of the following locations: Melville, NY; Raleigh, NC; Syracuse, NY; Fairfax, VA; or Sunrise, FL.

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.