Contract Variance Specialist - PB and HB

TriHealth • Cincinnati, OH

4h • Hybrid

About The Position

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.

Requirements

• 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

Nice To Haves

• Associate's Degree or Diploma in Business, Healthcare, or other related field

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 quaility and effective resolution practices.
• Addresses accounts by assigned payer in a expedient and effecitve manager.
• Minimum expectation is 210 accounts/weekly.
• Demonstrates knowledge of all systems and tools used to perform job functions, which may include any combination of multiple systems, including but not limited to: Epic, Availity, Florida Shared, WebMD, Passport, MedAssist Knowledge Base, On Base, payer websites, etc.
• 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 represenatives and utilizes him/her, payer websites and claim error spreadsheets regulary 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.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED