Payment Variance Analyst

Payment Variance Analyst

The Analyst will evaluate and understand contract language as it relates to reimbursement methodologies including those involving, but not limited to, Per Diems, DRG's, Fee Schedules and Percent of Charge Mechanisms. Evaluates payer performance through analysis, investigation and facilitation of resolution. Communicates contract issues, interpretation and modifications to internal/external parties, as appropriate. Duties include reviewing, analyzing and appealing payer underpayments, payer contract variance recoveries and conducting follow up activity with Managed Care team for rate sheet modifications. The Analyst will 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. This position is considered a subject matter expert and uses level of proficiency and knowledge to ensure quality and efficiencies in operational processes.

Meets quality measures set forth by regulatory compliance standards, organization, and department. Displays high customer service standards. Serves as a key point person for providing organization details for underpayment and denials. Has a strong ability to communicate information to peers, and management.

Minimum 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
• Ability to demonstrate attention to detail
• Excellent communication skills, oral, written and by use of telephone
• Excellent customer service skills

Preferred Qualifications:

• Health care experience in a hospital setting