Payment Variance Follow Up Representative

About the role

The Payment Variance Follow Up Representative is responsible for collecting outstanding insurance reimbursement due to contractual discrepancies.

Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
• Perform payment variance analysis to identify trends in underpaid claims
• Identify and report underpayments and denial trends
• Initiate appeals when necessary
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients
• Maintain confidentiality at all times
• Maintain a professional attitude
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• High School Diploma or equivalent required
• 3 years’ experience in Commercial insurance collections, including submitting and following up on claims
• Experience in Hospital/Facility billing
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Detailed knowledge of Managed Care reimbursement methodologies
• Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04
• Ability to analyze, identify and resolve issues causing payer payment delays
• Proficiency with MS Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.