BioScrip, Inc. Senior Payor Analyst in Aurora, Colorado

Senior Payor Analyst

Location: Aurora, CO

Job Id: 4973

of Openings: 1

BioScrip, Inc. is the largest independent national provider of infusion and home care management solutions, with approximately 2,100 teammates and nearly 70 service locations across the U.S. BioScrip partners with physicians, hospital systems, payors, pharmaceutical manufacturers and skilled nursing facilities to provide patients access to post-acute care services. BioScrip operates with a commitment to bring customer-focused pharmacy and related healthcare infusion therapy services into the home or alternate-site setting. By collaborating with the full spectrum of healthcare professionals and the patient, BioScrip provides cost-effective care that is driven by clinical excellence, customer service, and values that promote positive outcomes and an enhanced quality of life for those it serves. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of welfare benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) Retirement Savings.

Due to our exceptional growth and success, we are recruiting for aSenior Payor Analyst to join our team.

SUMMARY

This position analyzes payor-related issues and develops recommendations for resolution within BioScrip’s Revenue Operations. This position also ensures recommendations are implemented consistently throughout the department. This position is the ROPS contact within the department for escalation, communication, and resolution of complex payor and billing issues.

ESSENTIAL FUNCTIONS

To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.

  • Analyze payor metrics reports to proactively identify payor issues; develop recommendations for resolution

  • Ensure solutions are implemented consistently in ROPS throughout the department

  • Collaborate with business partners to gather and update issues for payor reviews and draft presentations

  • Research complex claim issues; identify root causes and resolutions

  • Coordinate efforts to identify entire claim population

  • Escalate issues as needed; provide recommendations

  • Serve as inter-department resource and subject matter expert regarding payor related claim issues

  • Identify and interpret policies related to exceptions

  • Determine and apply appropriate business action in absence of policies or in cases of ambiguity

  • Draft internal/external communications related to resolutions

  • Manage and lead special projects related to primary payors; coordinate projects with business partners in all collections teams

  • Partner with analytics team to identify information required for ad hoc reporting requests

  • Participate in discussions with management regarding key performance metrics; provide recommendations for improvement

  • Develop and maintain strong relationships with internal operational teammates

  • Identify, recommend, and facilitate opportunities for department education

  • Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and BioScrip policies

  • Provide support for department initiatives as needed

  • Lead special projects as necessary

  • Attend team meetings, phone conferences, and training as needed

  • Know, understand, and follow teammate guidelines, employment policies, and department or company procedures

  • Each employee is responsible for adhering to those performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company. Each employee must be made aware of and understand proper internal control procedures associated with their specific job function as communicated by his/her manager.

  • Each employee is responsible for reporting concerns that he or she may have with respect to deficiencies in internal control.

  • Performs other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS

  • Bachelor’s degree in related area preferred.

  • Minimum of five (5) years’ experience in business analysis including project management required; healthcare business experience strongly preferred

  • Demonstrated process improvement experience preferred

  • Intermediate computer skills and proficiency in MS Word, Excel, PowerPoint, and Outlook required

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.

  • Working knowledge of medical terminology.

  • Knowledge of HCPCS coding.

  • Knowledge of ICD 9 coding.

  • Knowledge of NDC coding.

  • Knowledge of electronic billing.

  • Excellent calculation/math skills.

  • Ability to understand insurance contracts for billing purposes.

  • Ability to prioritize and handle multiple tasks and projects concurrently.

  • Strong interpersonal and communication skills and the ability to work effectively with branch departments.

  • Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.

  • Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office.

  • The ability to work with confidential material and maintain confidentiality is required along with sensitivity to employees and customers needs and data.

  • Strong attention to detail.

  • Proficient analytical skills.

  • Travel may be required: up to 15%

Language Skills

Ability to read, analyze and interpret information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from patients, and payors.

Mathematical Skills

Ability to perform basic mathematical calculations.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.

BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.