Payment Variance Analyst
About The Position
The Payment Variance Analyst identifies opportunities to obtain additional reimbursement resulting from contractual payment discrepancies. The role uses managed care contracts to determine whether payers are following applicable rates, provisions, and terms. The analyst reports identified discrepancy root causes to the manager. The Payment Variance team collects outstanding reimbursements resulting from contractual discrepancies and insurance payer underpayments. The analyst performs payment variance analysis, prepares and reviews underpayment data, supports accurate contract pricing and reporting, monitors client heat maps, and works with client leadership, internal teams, and payers to resolve underpayments and denials. The role also provides support to Payment Variance Specialists, initiates appeals when needed, and identifies recurring payment patterns and issues. The position requires compliance with HIPAA and information security policies, including limiting access to protected health information to the minimum necessary. A smartphone or electronic device capable of downloading applications is required for multifactor authentication and security purposes. The work environment is usually quiet. The role involves occasional movement around the work area and use of office equipment, and requires the ability to follow directions, collaborate, and handle stress.
Requirements
- High school diploma or equivalent.
- Two years of experience in commercial insurance collections, including submitting and following up on claims.
- Two years of underpayment analyst experience.
- Detailed knowledge of managed care reimbursement methodologies.
- Experience in hospital or facility billing.
- Ability to adapt to learning a wide range of systems and regulations.
- Proficiency in Microsoft Office Suite.
- Strong interpersonal skills and ability to communicate well at all levels of the organization.
- Strong problem-solving and creative skills, sound judgment, and ability to make decisions based on accurate and timely analyses.
- High integrity and dependability, a strong sense of urgency, and a results-oriented approach.
- Excellent written and verbal communication skills.
- Gracious and welcoming personality for customer service interactions.
- A smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.
- Ability to occasionally move around the work area, sit, perform manual tasks, operate office tools and equipment, extend arms, kneel, talk, and hear.
- Ability to follow directions, collaborate with others, and handle stress.
Responsibilities
- Perform payment variance analysis to identify trends in underpaid claims.
- Request and prepare payer underpayment data in a uniform format for internal Payment Variance Specialists to validate.
- Analyze data and work with Analytics and/or Pricing teams to resolve contract load variances and produce accurate reporting.
- Analyze client heat maps monthly for accuracy.
- Identify and report underpayment and denial trends to client leadership, and track resolution and collection of underpaid claims.
- Escalate issues with payers or managed care teams to collect and resolve underpaid claims.
- Provide project support and guidance to Payment Variance Specialists and support the team as needed.
- Initiate appeals when necessary.
- Track recurring underpayment patterns and systematic issues.
- Analyze, identify, and resolve issues causing payer payment delays, including billing and coding errors.
- Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
- Comply with Information Security and HIPAA policies and procedures, limiting access to protected health information to the minimum necessary.
- Perform other duties as assigned.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
High school or GED
