Contract Variance Specialist - PB and HB

TriHealth•Cincinnati, OH

19h•Hybrid

About The Position

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. 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 (Preferred)

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.
Learns and follows corporate and department policies and procedures and workflows.
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.