Provider Payment Support Analyst Senior

Job Summary:

QTC is seeking a Provider Payment Support Analyst who will be responsible for identifying and resolving payment issues for all providers supporting QTC. This position supports the development and finalization of payments to all providers across all contracts and all lines of business. This position executes and enhances provider payment practices and policies, understands payment provisions in provider contracts, delivers on payment schedules, utilizes system reports and other resources (e.g. Dashboard, eProcess, Tracking Tool, PIBS, Provider Admin Portal, Exam Track, eRequester, Tableau, Interdepartmental SharePoint sites, etc.) to troubleshoot provider payment inquiries and/or internal payment discrepancies in an effort to support accurate reimbursement to providers. This position looks for ways to continuously improve the function to maintain and strengthen ties with all providers.

*This opportunity requires one to live within a commutable distance to the QTC office in San Dimas, CA. This role will be hybrid with two to three days in-office.

Essential Duties and Responsibilities:
• Responsible for all payments to all providers in accordance to contract and provider fee schedules; analyze and reconcile to identify any discrepancies that need to be reported to Credentialing and Accounting to ensure variances are addressed and corrected prior to payment disbursement
• Support the development of explanation of payment (‘EOP’) report to serve as document of record for payment due to all providers for services rendered; upload EOPs for third party mailings in coordination with Accounting and implement work arounds for all other lines of business that have different system requirements
• Daily rotation working PPS Dashboard, email account, and eRequesters, including but not limited to requests for additional payments, closing of cases, copies of EOPs, no-show requests (review and entry), payment status, per diem payments, provider rate discrepancies, provider service discrepancies, transcriber payments, and various provider inquiries and/or concerns on the status and accuracy of their payments for services provided
• Perform research and analysis on complex requests to identify issue(s) with the utilization of Tableau data, Tracking Tools and PIBS as well as providing direction on systematic updates to all internal stakeholders involved
• Responsible for troubleshooting provider payment issues to ensure accurate and timely reimbursement to providers; work with Accounting and all internal leaders on issue resolution and payment authorization
• Work with Operations to ensure proper procedures and all internal workflows are followed and in line with contractual agreements
• Serve as liaison between QTC and all physicians/providers to resolve payment discrepancies; provide excellent customer service to ensure the solutions address all current payment issues and concerns, and validate systems reflect correct setup to enable accurate provider payment provisions for future payments
• Generate and scrutinize Tableau/Excel reports to resolve provider inquiries and/or issues being worked on; recommends report/file enhancements to improve future analysis and/or application to new lines of business
• Work on initiatives to correct overpayments and/or underpayments to all providers originating back to negotiation of payment provisions in their contract; may identify provisions that were omitted or entered incorrectly, requiring reimbursement from client or, in some cases, QTC directly
• Perform other duties and responsibilities as assigned

Competencies:
• Knowledge of ICD-9 (International Classification of Disease, Ninth Edition), CPT and HCPC (Healthcare Common Procedure Coding System) coding, medical terminology and CMS (Centers for Medicare & Medicaid Services) guidelines including NCCI (National Correct Coding Initiative) edits and medical billing practices
• Ability to manage competing priorities with a sense of urgency
• Ability to work independently, take initiative and be self-motivated with a high volume and fast paced environment.
• Possess excellent organizational and follow up skills with a strong attention to detail
• Strong computer skills and web based applications; ability to learn new programs based on business needs
• Effective critical thinking, problem solving, analytical and trouble-shooting skills; knowledge of business and accounting processes
• Strong organizational and time-management skills; demonstrated attention to detail
• Proficient with MS Office; strong emphasis with Excel
• Ability to use Tableau, SharePoint programs, and navigate multiple systems at the same time to perform daily tasks.
• Strong communication and customer service skills, both verbal and written for internal and external stakeholders with the ability to resolve into elements and explain decisions and outcomes
• Solid understanding of HIPAA privacy practices
• Awareness of all provider contracts and fee schedules for all lines of business

Education and/or Experience: (includes certificate & licenses):
• High School diploma, or equivalent (GED) required, vocational degree/certification highly desired
• 0 to 1 year of prior QTC related experience, highly desired
• Medical Billing Certification preferred
• Medical terminology in a medical billing environment is highly desirable

Pay and Benefits:

Salary/Hourly range: $21.00 – $23.00

Pay and benefits are fundamental to any career decision. That’s why we craft compensation packages that reflect the importance of the work we do for our customers. Employment benefits include competitive compensation, performance-related bonuses, health and wellness programs, student loan repayment and tuition reimbursement, paid leave and retirement. More details are available here.

The QTC pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.

This job description supersedes all prior job descriptions and is intended to describe the general content and essential requirements for the position listed above. It is not to be construed as an exhaustive statement of requirements, duties and responsibilities. Management reserves the right to add or change the duties of this position as required at any time.

QTC Management Inc. is a VEVRAA Federal contractor and an Equal Opportunity Employer. The company has an ongoing commitment to affirmative action and the creation of a workplace free of discrimination, harassment and retaliation. The company recruits, hires, trains, and promotes individuals in all job titles without regard to race, color, creed, religion, ancestry, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, people with disabilities protected under law, and protected veteran status.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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