Position Summary:

The Payer Relations Representative supports the resolution of Unapplied Cash Category 1 (UAC Cat 1) by ensuring the accurate receipt and processing of electronic remittance advice (835 files). Working under limited supervision, this role involves using queries to locate missing files, collaborating with the internal EDI team, reaching out to payers, and resolving file-related exceptions. The representative communicates progress with internal teams and plays a key part in maintaining accurate payment application within the revenue cycle.

Primary Accountabilities:

• Communicate with Pharmacy Benefit Managers and Insurance Carriers to retrieve missing electronic remittance advices
• Resolve exceptions on received files by analyzing data trends and adjust system configuration at payer level
• Complete specific assigned tasks that support the overall workflow
• Advise on conversion opportunities from paper remittance advice to electronic remittance advice
• Trend and research failed and missing 835's for open unapplied cash
• Parse out and validate electronic remittance (835 files) for delivery to outside entities
• Follow HIPAA policies and procedures per company guidelines
• Communicate any known issues to Client Services and Operations team members

Preferred Qualifications:

• 4 Year College (Bachelor's Degree)
• 3-5 years of related work experience and/or any equivalent combination of experience and training that provides the required knowledge, skills, and abilities needed to complete the major responsibilities/essential functions of the position.
• Proficient in Microsoft Windows, Microsoft Office (including Excel and SQL), Text editors (including Ultra Edit and Notepad++)
• Competent in Google Office Suite