Position Title: Payor Management Specialist I & II

Effective Date: 1/1/2024

Reports To: Payor Relations and Coding Manager

Position status: Exempt Full-Time

Primary Function:

Work with the outsourced revenue cycle team to ensure claims are billed accurately. Support contracting to ensure contracts are maintained and managed accordingly. Payor Management Specialist II may be assigned one of multiple roles listed below based on experience, education, and knowledge. Payor Management Specialists may be cross trained to ensure adequate coverage for any other department if the need arises.

Essential Duties and Responsibilities:

XiFin Programming

• New insurance payor setup, Molecular Testing Labs (MTL) will populate form for XiFin to load.

• New Test ID setup and pricing, XiFin will load information.

• Coding for new testing reviewed and researched for payor policy and payment trends.

• Fee Schedules reviewed and updated annually, CASH and Third-Party schedules.

• ICD10 coding reviewed and updated, listing sent to LIS for manual update. Updated annually.

• Consolidation rules for coding reviewed for new testing.

• Incremental pricing tables reviewed for new testing.

Auditing/Medical Reviews

• Manage payor audits received, this includes requesting records, reviewing records, and formulating a response. Escalating to legal and compliance when necessary.

• Manage CERT (Comprehensive Error Rate Testing-CMS) requests and reviews.

• Review monthly listing for providers who do not open reports to ensure they are reviewing and using the test information ordered and provided.

• Quarterly review of CLIENTs coming over to XiFin from LIS registration.

Education

• Providing training and education on new lines of business and current LOB as able.

• Create and train sales staff on new lines of business when needed example is UTI.

• Review upcoming releases and changes to/from XiFin and relay to applicable staff departments.

• Review new policies and changes as assigned, e.g., LCD, NCD, CPT, HCPCS, MUE, and NCCI.

• Register and maintain facility/client information in XiFin. This includes setup, fee schedules per LSA's and reason codes associated with the appropriate payor payment for the CLIENT responsibility.

• Manage Invoicing email, this email receives requests for reprints of invoices, demographic changes, questions on invoices and any other questions related to the invoices sent.

• Monthly review of accessions moved to CLIENT bill as well as monitoring of any CLIENT moved to collections.

• Manage and onboard straight CLIENT bill invoicing that does not include payor billing. Upload pricing and items to bill straight to CLIENT.

Contracting

• Manage contracting email.

• Manage revalidations of state and federal payors with which we are enrolled.

• Submitting letters of interest and reaching out to payors as directed by BD for states and areas we expect to do business with.

• Provide update requests for CLIA, Licensing, W9's and MTL Insurance.

• Support and organize site visits of the lab as requested by state payors.

Billing Office Address Change

• Review incoming mail with incorrect business address and work to ensure the address is updated accordingly.

• Update address and lockbox information for payor websites that require a different process than a mailed letter.

Website Access

• Work incoming requests for user access to revenue cycle systems. This includes XiFin, Noridian, Availity, and any other website the user needs to perform duties. This includes XiFin staff needing access to payors’ websites for proper payor follow-up.

• Work requests for deactivations to ensure that the user can no longer access websites under MTL or XiFin.

Skills, Knowledge, Abilities:

Mental Abilities and Skills Requirements-

• Exceptional verbal and written communication skills
• Ability to work independently on assigned tasks with limited to no supervision.
• Ability to assume tasks outside of your typical scope of work as needed to ensure success of the revenue cycle department.
• Ability to prioritize work to ensure most important deliverables are accomplished on time and with accuracy.

Knowledge Needed-

• Understanding of the revenue cycle process from registration to accurate claims payment or adjustment
• Knowledge of electronic equipment and computer hardware and software, including applications and programming.
• Intermediate to advance in Microsoft Word and Excel

Education and Certification:

Education/Experience Requirements-

• High School Diploma or GED
• Minimum 5 years with a provider office or health insurance carrier in the field of registration, billing, or patient accounting
• Ability to perform cross-functionally three or more of the individual roles above with limited training.

Certifications-

• N/A

Physical Requirements:

• Must be able to sit or stand for up to eight hours per day.
• Occasionally required to lift up to 20 lbs.
• Regularly required to sit, stand, bend, reach, and move about facilities.

Work Environment:

REMOTE POSITIONS - Most work will be performed away from the office in the employee’s home or in another remote work site. However, this position may require some traveling and working between locations. Workweeks usually consist of 40 hours.

Tools and Technology:

• Desktop computer and laptop
• Scanners and printers

Hazards:

• Work is performed in an office environment, full manual dexterity and visual acuity required. However, access to the laboratory may be necessary and therefore employee may be exposed to potential physical harm from hazardous chemicals, infectious diseases, bloodborne pathogens, toxic materials, toxic gases, electrical hazards, dangerous tools, and equipment.
• Hep B Vaccination provided at no cost to employee.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by associates assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Molecular Testing Labs embrace diversity and is an Equal Opportunity Employer, and hire without regard to any individual's race, age, color, national origin, ancestry, disability, veteran status, religion, marital status or domestic partnership; pregnancy, childbirth or related medical conditions; other medical conditions or genetic characteristic; sexual orientation, gender, gender identity or transgender status; or any other basis protected by state, federal or local law, regulation or ordinance. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Molecular Testing Labs provides reasonable accommodation upon job seeker request in all steps of the employment process.