Payment Variance Analyst

Duties

• Evaluate and understand contract language as it relates to reimbursement methodologies including Per Diems, DRG’s, Fee Schedules and Percent of Charge Mechanisms.
• Evaluate payer performance through analysis, investigation and facilitation of resolution.
• Communicate contract issues, interpretation and modifications to internal/external parties, as appropriate.
• Review, analyze and appeal payer underpayments, payer contract variance recoveries and conduct follow-up activity with Managed Care team for rate sheet modifications.
• Provide customer service/provider service resolution by identifying and communicating problems with key contracts.
• Has extensive knowledge in Medicare, Medicaid, and third party payment programs.
• Thorough understanding of payer contract terminology.

Requirements

• Bachelor’s degree or equivalent obtained through a combination of education and experience.
• Minimum of two years’ experience in managed care or government payer payment variance reconciliation.
• Experience with 837i and HIPAA transaction sets such as ICD/CPT/HCPC coding, revenue codes, ICD10 and knowledge of medical terminology.
• Critical thinking and problem solving skills.
• Proficient in use of Microsoft Office products.
• Expert level in use of spreadsheets for analysis purposes.
• Graphic Presentation skills.
• Able to demonstrate attention to detail.
• Excellent communication skills, oral, written and by use of telephone.
• Excellent customer service skills.

Qualifications

• Health care experience in a hospital setting is preferred.