Payment Variance Rep, FT, Days, - Remote

Inspire health. Serve with compassion. Be the difference.

Job Summary

Ensures claims are paid appropriately pursuant to negotiated payment rates in Hospital’s contractual agreements with all insurance payors. Evaluates and submits payment discrepancy disputes when appropriate.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.

• Abides by all applicable policies, procedures, and guidelines of the Prisma Health System.

• Analyzes payor payments and collaborates with other departments to process appeals and resolve appropriate underpayments. This includes application of appropriate contract terms, fee schedules, identification of trends, and reporting trends to management.

• Research insurance credit balances/adjustments to ensure accuracy of transactions and appropriate disbursement of funds due to insurance payors.

• Ensures timely follow-up and appropriate action for assigned accounts.

• Reviews payor refund requests to resolve reimbursement discrepancies. Initiates appeals or adjustments based on contract interpretation, payor policies and procedures.

• Meets productivity and quality standards according to departmental policy.

• Troubleshoots claim pricing in Prisma Health’s Information Systems and offers suggestions for improvement.

• Makes recommendations regarding complexity of claim resolution and the appropriateness of transferring account to collection vendor(s) or other resources for follow-up.

• Works with team members and management to participate and provide comprehensive training regarding appeals processing, process improvement, payor contracting and revenue cycle issues that impact reimbursement.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned

• Experience - Five (5) years bookkeeping, invoice/account reconciliation or healthcare revenue cycle/medical office experience. Managed care, payor contracting & reimbursement, denials and/or appeals experience preferred.

In Lieu Of

• In lieu of education and experience noted above, a Bachelor’s degree and two (2) years of related work experience may be considered.

Required Certifications, Registrations, Licenses

• Certified Specialist Payment & Reimbursement (CSPR) preferred

• Certified Revenue Cycle Representative (CRCR) preferred

• Certified Revenue Cycle Representative (CRCR) preferred

Knowledge, Skills, and Abilities

• Communication skills.

• Microsoft Office Skills, including the use of pivot tables and other functions in Excel.

• Critical thinking and analytical skills.

• Ability to work autonomously.

• Working knowledge of CPT and DRG coding practices.

• Ability to evaluate and prioritize workload.

• Ability to quickly problem solve and identify appropriate issues for escalation to management.

• Working knowledge of billing requirements for Government and Commercial Payors.

Work Shift

Day (United States of America)

Location

Corporate

Facility

7001 Corporate

Department

70019122 PBO-Patient Account Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.