Payment Variance Analyst, Corporate Business Office, Full-Time, Days

Jackson Health•Miami, FL

77d•Onsite

About The Position

CBO Payment Variance Analyst perform various interviewing, fact collection and financial evaluation tasks in connection with credit and collection in a large and diversified hospital serving both non-indigent and indigent patients qualifying for various types of specialized assistance programs. Incumbents may specialize in either credit or collection work or a combination of both. Primary emphasis is on financial counseling with patient from pre-admission through account becoming a discharged zero balance. Incumbents are responsible for interview of patient, family or guarantor to explain charges, hospital policy and payment procedures. Patient Finance Associates are responsible for confirming all commercial insurance and conducting extensive third party and welfare program finding in order to obtain payments as promptly as possible or direct account to collection agency.

Requirements

Generally requires 3 to 5 years of related experience.
High school diploma is required.
Must possess a valid State of Florida Operator's license.

Nice To Haves

Bachelor's degree in related field is strongly preferred.

Responsibilities

Identify and resolve accounts that have had payment activity, including zero paid amounts posted to claims as a result of denials.
Work with the hospital staff, physicians, patients, payors and other members of the CBO team to resolve payor discrepancies.
The PVA must be able to understand how the Payor adjudicated the JHS claim and effectively communicate these discrepancies to the appropriate party or parties to bring the claim to the expected resolution.
Will require the ability to analyze patient account balances and submit adjustment or payment transfers to the appropriate management approval.
Update JHS Patient Accounting Systems with any changes that may be necessary to accurately reflect the patients demographic and financial information to include but not limited to the patients financial class, insurance eligibility, patient balance, etc. based on follow-up calls or new information through collection efforts or correspondence.
Determine if payments are accurate based on the Payor agreement.
Will be required to understand a variety of payment mechanism from DRGs, Stop Gap, Percent of Charge, Per Diem and/or any other special agreements that JHS has or will contract with to secure payment of the patient receivable.
Will be required to work with a variety of payors.
Contact Payors and Debtors to ensure timely payment and account resolution.
Research, resolve accounts and document all follow up activity and post comments into the JHS Patient Accounting System.
Documentation of account activity should be concise and easily understood by anyone that may need access to the patient accounting record to include others staff members within the department, hospital staff members that may need to understand past billing and collection activity, and auditors or others that require billing and collection information that are designated as an approved source (i.e. courts, lawyers, payers, etc.).
Validate and determine if all data on account is accurate to bring the account to resolution.
Use daily work list or other appropriate account listing (ATB, etc.) to determine accounts that need to be worked each day.
Ensure that their assigned management team member is made aware of any issues with accessing their assigned work list or other issues that can impact the volume of work each day.
Routinely work with supervision and management to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
The PVA should be able to identify trends of denials or other payor issues and report those issues to the management team in the CBO.
Quickly respond to changes in the Payor requirements and regulations to improve collections and be able to effectively communicate those changes to the other members of their team that may be impacted by updated Payor information.
Maintain productivity and quality standards in accordance with department policy and procedure.
Continually improve knowledge of Medicare, Medicaid, and other third party Payors to insure a clear understanding of Payor requirements that may required to facilitate the billing and reimbursement process using multiple hospital and Payor systems.
Must be very detail-oriented and accustomed to high volume output utilizing telephone, fax, Payor websites, CMS common working file, and/or Medicaid's website.
Work directly with other departments and physicians that may provide information on collecting JHS account receivable.
Will be required to develop and maintain good working relationships with others that impact the collection of JHS receivables.
Ensures proper use of all information systems available within the Hospital technology platform.
Complies with HIPPA and JHS requirements as it relates to Patient Health Information.
Will use JHS technology system strictly for their intend use.
Adhere to JHS and Departmental policies and complete annual testing as may be required by various regulatory agencies, JHS, and/or the CBO.
Attend mandatory training and maintain proficiency with the ability to pass job related skills tests with 85%.
Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
Performs other job duties that may be required to provide the quality and level of service expected by JHS and Revenue Cycle management.