Payer Maintenance Coordinator

Summary

Join iRhythm as a Payer Maintenance Coordinator and act as a liaison between departments, vendors, and the revenue cycle to ensure accurate contract information in the system. You will utilize critical thinking to clarify contract details, maintain payer changes, confirm routing, update EHR maps, and resolve payer issues. Responsibilities include updating contract information in systems, completing payer maintenance processes, collaborating with quality and audit teams, reviewing insurance contracts, and communicating with finance and accounting teams. The role requires a high school diploma, 4-6 years of experience in health insurance and billing, and significant knowledge of regulatory and payer requirements. Preferred qualifications include experience with Microsoft Office and CRM systems and a secure HIPAA-compliant workspace. iRhythm offers a competitive compensation package, excellent benefits, and a supportive work environment.

Requirements

• High school diploma required
• Minimum 4 to 6 years of experience with health insurance and billing operations
• Significant knowledge of regulatory and payer requirements for reimbursement
• Strong command of the health insurance reimbursement and claim adjudication processes including denial codes, experience with claims processing by large national payers, and exposure to navigating through clinical documentation to pull out supporting detail
• Strong Written & Communication Skills
• Problem Solving
• Quality Focused
• Adaptable
• Analytical
• Accountable
• Solution oriented
• Work Independently

Responsibilities

• Update contract status, rates, UM criteria, contract criteria within all relevant systems
• Complete payer maintenance processes to ensure the proper updates within internal systems and external partners
• Collaborate with Quality and Audit teams on SOX controls and ensure all steps are completed in a timely fashion and meet audit standards
• Review insurance contracts and communicate the impact they have on revenue recognition
• Participate in open dialogue with Finance and Accounting teams regarding changes in rates, contractual allowance or payment integrity, and payer contracts review quarterly and year over year differences
• Research payer requirements for utilization in order to update the payer page
• Will work with internal and external stakeholders to obtain clarity and ensure accurate data is entered
• Comfortable and capable utilizing various communication tools including TEAMs and video conferencing to enable virtual work collaboration
• Validate external processes including payer designations and relationships
• Cross-functional work groups with the Electronic Health Records Integration teams including leading feedback communications

Preferred Qualifications

• Ability to work independently as an individual contributor and adapt quickly to changing priorities
• Experience with Microsoft Office and CRM casing/ticketing systems, preferably salesforce.com
• Possess a secure work area conforming to HIPAA guidelines
• Self-awareness to find creative solutions to remote challenges
• Resourcefulness and high levels of emotional intelligence to identify obstacles and collaborate with others to discuss potential solutions

Benefits

• Competitive compensation package
• Medical, dental, and vision insurances (all of which start on your first day)
• Health savings account employer contributions (when enrolled in high deductible medical plan)
• Cafeteria plan pre-taxed benefits (FSA, dependent care FSA, commute reimbursement accounts)
• Travel reimbursement for medical care
• Noncontributory basic life insurance & short/ long term disability
• Emotional health support for you and your loved ones
• Legal / financial / identity theft/ pet and child referral assistance
• Paid parental leave
• Paid holidays
• Travel assistance for personal trips and PTO!
• 401(k) (with company match)
• An Employee Stock Purchase Plan
• Pet insurance discount
• Unlimited amount of Linked In Learning classes