Payment Variance Analyst

Med Metrix•Parsippany-Troy Hills, NJ

12h

About The Position

Job Purpose The Payment Variance Analyst will identify opportunities to pursue additional reimbursement due to contractual payment discrepancies. This role will make use of managed care contracts to determine appropriate rates, provisions and terms are being followed by the payers. The Payment Variance Analyst will report any root causes for the discrepancies identified to the manager. The Payment Variance team is responsible for collecting outstanding reimbursements left due to contractual discrepancies and insurance payer underpayments. Duties & Responsibilities Perform payment variance analysis to identify trends in underpaid claims Request and prepare data for payer underpayments in uniformed fashion to send to internal Payment Variance Specialists for complete validation Analyze data and work with Analytics and/or Pricing teams to resolve contract load variances and produce accurate reporting Monthly analyze client heat maps for accuracy Identify and report underpayments and denial trends to client leadership and track for resolution and collections of underpaid claims Perform escalations with payers or managed care teams for collection and resolution of underpaid claims Provide support and guidance to payment variance specialists on projects and support the team as needed Initiate appeals when necessary Track reoccurring underpayment patterns and systematic issues Analyze, identify and resolve issues causing payer payment delays including billing and coding errors Other duties as assigned Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Requirements

High school diploma or equivalent required
2 years’ experience in Commercial insurance collections, including submitting and following up on claims
2 years’ experience of underpayment analyst experienceDetailed knowledge of Managed Care reimbursement methodologies
Experience in Hospital/Facility billing
Ability to adapt to learning a wide range of systems and regulations
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes

Responsibilities

Perform payment variance analysis to identify trends in underpaid claims
Request and prepare data for payer underpayments in uniformed fashion to send to internal Payment Variance Specialists for complete validation
Analyze data and work with Analytics and/or Pricing teams to resolve contract load variances and produce accurate reporting
Monthly analyze client heat maps for accuracy
Identify and report underpayments and denial trends to client leadership and track for resolution and collections of underpaid claims
Perform escalations with payers or managed care teams for collection and resolution of underpaid claims
Provide support and guidance to payment variance specialists on projects and support the team as needed
Initiate appeals when necessary
Track reoccurring underpayment patterns and systematic issues
Analyze, identify and resolve issues causing payer payment delays including billing and coding errors
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties