Reimbursement Variance Analyst

POSITION SUMMARY

Responsible for maintenance of clinic professional charges including updating of procedure and diagnosis codes and associated fee schedule in the practice management system, analysis of reimbursement data to identify and resolve variances, and patient and insurance refunds.

RESPONSIBILITIES AND ACCOUNTABILITIES

• Fee Schedule Maintenance:
  • Updates existing fee schedules with payer allowed amounts annually (or as necessary)
  • Attaches new schedules to all providers, expiring old schedule
  • Monitors CMS & commercial payer websites and transmittals for regulatory changes in reimbursement policies
  • Revise Standard Fees to comply with federal & state billing regulations & guidelines
• Payment Variance Analysis:
  • Runs carrier variance reports and researches payment inconsistencies identified
  • Corrects invalid allowed amounts in corresponding fee schedules
  • Appeals underpayment errors with carriers
  • Identifies & reports carrier trends to Director
• Insurance Overpayments / Refunds:
  • Validates insurance overpayments in demand letters from carriers and refund requests from A/R reps, making appropriate account adjustments as needed
  • Runs monthly credit balance reports to identify patient overpayments, conveys funds when appropriate, and places account in refund status
  • Forwards refund requests to Finance Department staff with supporting documentation
  • Processes patient and insurance refund checks for mailing with appropriate claim reconsideration forms or explanation letter, verifying payee name and address
• Customer Service and Communications:
  • Communicates with patients, insurance carriers and other outside entities in a professional manner
  • Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc.
  • Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person
  • Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload
  • Communicates with staff members in a professional, pleasant manner
  • Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance
• TEAMWORK
• Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision
• Works cooperatively and refrains from participating in negative conversations
• Shares knowledge and insights with co-workers in a constructive manner
• Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers
• Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.
• POLICIES AND PROCEDURES
• Policies and Procedures
• Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents
• Provides assistance and support to leadership in implementing policies and procedures as necessary
• Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs

QUALIFICATIONS

• Education, Experience, Certification and Licensure Requirements:
• High School Diploma or equivalent required
• Previous medical billing experience, preferably in an orthopedic surgery specialty is required
• Candidates must have current certification as a Certified Professional Coder
• Proficiency with software including practice management systems and Microsoft Excel
• Location:
• Orthopedic One Patient Accounts
• Schedule:
• Regular Full Time, Day Shift