Contract Variance Specialist - PB and HB

Senior Account Specialist or Account Specialist II

At TriHealth, our corporate teams are driven by a service-oriented mindset and a shared commitment to inclusivity, innovation, and collaboration. We cultivate a supportive, people-first culture where every team member is valued, respected, and empowered to succeed, fostering a strong sense of belonging and personal well-being. Team members benefit from meaningful growth and development opportunities, excellent benefits, and a collaborative environment where colleagues support one another, share best practices, and work together each day to make a meaningful impact on the communities we serve.

Location: 625 Eden Park Dr. Role is onsite daily through training and then onsite 3x weekly as scheduled.

Schedule: Full-time, Day shift schedule. No weekends, no holidays. Variable schedule start time of choice 7AM, 7:30AM, 8AM.

We offer competitive shift differentials where applicable, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement.

Minimum Job Requirements:

• Associate's Degree or Diploma in Business, Healthcare, or other related field (Preferred)
• High School Diploma or GED (Required)
• 3 - 4 years experience Professional Healthcare Revenue Cycle (Required)
• Working knowledge of Epic Resolute, Excel, understanding of managed care contracts and payment terms
• Billing and Follow Up experience
• Patient Access and/or HIM knowledge

Job Overview:

The major responsibility of this position will be to identify payment variances at the account level based on expected reimbursement from contracted managed care payers, governmental payers and non-contracted miscellaneous payers. Knowledge and experience with revenue cycle, including the billing, follow up and payment processes, will be critical for success in this role, as well as experience with payer contract language and various payment methodologies. Knowledge of the Patient Access and/or HIM functions would also be helpful. Critical thinking skills, as well as the ability to identify trends and/or process improvement opportunities will be expected. This position will be the contract language expert for our many payers. To perform this role, working knowledge of various billing and payers systems will be required, as well as the ability to compare, analyze and communicate trends and/or problems is essential. This is a working position, meaning accounts identified to have a contract variance will be worked until payment as expected is received.

Job Responsibilities:

• Actively seeks to resolve accounts using all resources and tools available (phone, electronic, payer, etc.)
• Consistently achieves and/or exceeds volume productivity while maintaining quality and effective resolution practices
• Addresses accounts by assigned payer in an expedient and effective manner
• Minimum expectation is 210 accounts/weekly
• Demonstrates knowledge of all systems and tools used to perform job functions
• Learns and follows corporate and department policies and procedures and workflows
• Considered expert on payer contracts, medical policy and filing limitations
• Becomes familiar with provider representatives and utilizes him/her, payer websites and claim error spreadsheets regularly and effectively to get account resolution
• Uses strong problem solving and analytical skills
• Performs all aspects of job in a compliant and ethical manner
• Reports to work as scheduled and is engaged
• Seen as a "go to" person within the larger team given knowledge and understanding of the larger revenue cycle process and payer contracts
• Proactively communicates gaps to leadership and suggests solutions to identified problems
• Shares information, participates in goal setting and actively participates in payer and/or workgroup meetings to promote process improvement

Working Conditions:

• Climbing - Rarely
• Hearing: Conversation - Frequently Hearing: Other Sounds - Frequently
• Kneeling - Rarely
• Lifting <10 Lbs. - Occasionally Lifting <50 Lbs. - Occasionally
• Pulling - Occasionally Pushing - Occasionally
• Reaching - Occasionally Sitting - Occasionally Standing - Frequently
• Stooping - Occasionally Talking - Frequently Use of Hands - Frequently Color Vision - Frequently
• Visual Acuity: Far - Frequently Visual Acuity: Near - Consistently Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS

• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service

Respect: ALWAYS

• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone's opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS

• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS

• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community