Payer Integrity Specialist/UKHC

Job Title	Payer Integrity Specialist/UKHC
Requisition Number	RE48819
Working Title	Payer Integrity Specialist – Pharmacy Revenue Cycle
Department Name	H4026: REV Cycle M- PHARM Services
Work Location	Lexington, KY
Grade Level	08
Salary Range	$19.00-30.09/hour
Type of Position	Staff
Position Time Status	Full-Time
Required Education	BA
Click here for more information about equivalencies:	https://hr.uky.edu/employment/working-uk/equivalencies
Required Related Experience	3 yrs
Required License/Registration/Certification	None
Physical Requirements	This position requires the ability to occasionally stand or walk with objects weighing up to 25 lbs.; and regularly sit at a computer workstation for extended periods of time performing tasks requiring repetitive motions (such as typing). Some job-related travel (less than 10% of time) may also be required.
Shift	Monday through Friday, 8:00 a.m. – 5:00 p.m.
Job Summary	Under the direction of the Assistant Director and Contract Compliance Manager, the Payment Integrity Specialist is responsible for the collection and resolution of both inpatient and outpatient accounts from governmental, commercial, and/or managed care payers through the efficient analysis of payments in accordance with managed care contracts. This position is primarily concerned with effectively capturing accurate reimbursements, pursuing underpayments, and appealing denials.The Specialist will review, analyze, and interpret pharmacy claims to ensure accurate payments are received, payor contractual agreements and models are appropriate and complete, and all charges are valid. The Payment Integrity Specialist will also administer payor profiling to assist in contractual review and analysis for UK Managed Care contract negotiations and assist the UKMC Utilization Management Department with retrospective authorizations and appeals.The individual in this position will be responsible for the proactive identification of improved methods to accomplish Enterprise goals and must demonstrate flexibility in assignments to ensure those goals are achieved. Specialist will also provide customer service to both internal and external customers to provide for the sufficient collection of funds in order to support healthcare operations and participate in unit and Enterprise efforts to improve quality, efficiency, safety, and patient satisfaction.This is a remote position
Skills / Knowledge / Abilities	The ideal candidate will have a proficient understanding of the Revenue Cycle process and managed care contracts; strong analytical, critical-thinking, problem-solving, time management, follow-through, and planning and organizational skills; the ability to multi-task with a high regard for confidentiality, accuracy, and attention to detail; excellent communication skills, both written and verbal; extensive experience with and knowledge of Microsoft Office, specifically the applications Word, Outlook, PowerPoint, and Excel; in-depth HIPAA knowledge and medical, financial, and contractual terminology; proficient knowledge of medical coding (ICD-10, HCPCS, CPT); the ability to meet goals in a fast-paced setting without sacrificing quality or accuracy; and an individual who provides exceptional customer service and possesses a teamwork mentality, but can also thrive independently. Must also have the ability to compute basic math calculations using addition, subtraction, multiplication, division, and percentages. Experience with the following systems is a plus: McKesson, Allscripts Electronic Health Record (AEHR), EPSI, Sunrise Clinical Manager (SCM), Document Management System (DMS), Sunrise Record Manager (SRM), PageCenter X (PCX), Availity, 3M, ComplyTrack, Ambulatory Practice Management (APM), RevRunner, Navinet, SSI Billing, and Payment Integrity Compass (PIC). Epic Experience is appreciated.
Does this position have supervisory responsibilities?	No
Preferred Education/Experience	Bachelor’s degree and four or more years of third party insurance claims experience and at least three years of payer contract analysis and medical office/clerical employment experience highly preferred.
Deadline to Apply	01/29/2025
Our University Community	We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco & Drug Free campus.As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities.Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

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