Contract Variance Analyst Senior

Major Responsibilities:

Underpayments Management








: Oversee the Hospital (HB) and Professional (PB) Underpayments Management process.






Serve as the liaison to management






and for






payer meetings/escalation to address contractual variance issues




.






Optimize






net revenue related to reimbursement for hospital and professional services including research and interpretation of payer regulations and contract language




.






Provide key insights and recommendations to maximize net revenue within the current prevailing contract language for commercial/managed care and federal/state/ government contracts.






Provide guidance on






contract






payment discrepancies escalated by Variance Specialists.






Conduct quality reviews and






monitor






teammate productivity.






Recommend and update variance process






flow






documentation, policies, and procedures. Provide training and serve as a super user






for the department




.






Adhere to Revenue Cycle guidelines for Adjustment Authorization approvals.

Appeals Processing








: Ensure






timely






processing of appeals






in accordance with






payer




/contract






guidelines and Revenue Cycle policies. Escalate appeals in process when necessary.






Advise on






2nd Level Appeal submissions. Collaborate with departments such as Billing, HIM/coding, Case Management, and the medical team to obtain necessary medical documentation for underpayment appeals. Provide status updates on high-dollar and/or aged accounts to management.

Payment Variance Analysis








:






Identify




, analyze, and research root causes and






contract variance






tren




ds




. Develop and implement corrective action plans to resolve






payment discrepancies




.






Maintain






reports






identifying






accounts affected by trends/root causes and ensure their resolution. Work with internal and external partners to minimize preventable underpayments. Monitor and report progress and resolution of trends, evaluating their






financial impact






on the Revenue Cycle. Report






new trends






to management during weekly meetings.






Refer insurance and patient refunds to the Refund Team.

Operational Accuracy and Improvement








: Minimize internal inaccuracies causing false payment variances to increase revenue, streamline operations, and enhance






the patient






experience.






Identify






and escalate operational issues to improve organizational performance. Collaborate with Revenue Cycle Departments,






Managed Health




, Finance, and the Contract






Build






team to develop and implement corrective action plans to minimize preventable payment variances.






Ensure contractual allowances are






accurate




.






Work with management






to






implement changes to address internal process flow deficiencies.

Communication and Escalation








: Communicate and escalate problematic variances, delays, and significant reimbursement issues to management,






Managed Health, p




ayers, and other stakeholders. Report changes in payer requirements that significantly affect reimbursement and/or aging. Escalate underpayment issues to payer provider representatives and






aggressively






seek resolutio




n




. Compile and






submit






escalation reports for Payer/Department meetings. Inform management of significant






payer/contra




ct






issues with material






financial impact






on Revenue Cycle Operations




.






Refer insurance and patient refunds to the Refund Team.

Special Projects








: Complete special projects assigned by management accurately and






timely




. Gather, compile, and interpret data, department reports, and logs as requested. Prepare and implement strategic action plans and process improvement initiatives. Monitor and audit the execution of strategic initiatives, process redesign, metric/report development, and special projects for the Department. Collaborate closely with management to continually improve processes and positively






impact






the Revenue Cycle.

Policy Adherence








: Adhere to






Advocate Health




, Revenue Cycle, and departmental policies and procedures. Be accountable and






model






organizational behaviors of excellence.

Licensure, Registration, and/or Certification Required:

None Required.

Education Required:

Bachelor's Degree in Accounting




,






Health Care Administration or






Equivalent Experience

Experience Required:

6 years of Revenue Cycle or Managed Health experience related to payment resolution










at a large hospital or integrated healthcare delivery system.

Knowledge, Skills & Abilities Required:

Excellent management and leadership skills.

Excellent communication,






organizational






and customer service skills.

Excellent and thorough knowledge of all aspects of the hospital revenue cycle as well as the supporting systems, reimbursement and governmental regulations and reimbursement models in effect.

Demonstrate high performance of






leadership






skills including






ability






to work well with others, team building, organizational, communication and presentation skills.

Ability to work collaboratively across disciplines.

Excellent process redesign skills.

Highly customer focused.

Ability to interpret and understand a Managed Care Contract.

Knowledge of medical terminology, UB-04 requirements and CPT,






HCPCs






Coding.

Strong knowledge of PCI compliance and how it pertains to the Health Care environment.

Demonstrate






ability






to react quickly to an






ever-changing






environment.

Physical Requirements and Working Conditions:

This position






is remote. May






requires travel.

Operates






all equipment necessary to perform the job.

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.