Payment Variance Follow-Up Representative

Med-Metrix•Parsippany-Troy Hills, NJ

About The Position

The Payment Variance Follow-Up Representative is responsible for collecting outstanding insurance reimbursement due to contractual discrepancies. Duties & Responsibilities Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites. Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies Detailed knowledge of Managed Care reimbursement methodologies Perform payment variance analysis to identify trends in underpaid claims Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results. Identify and report underpayments and denial trends Initiate appeals when necessary Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04 Ability to analyze, identify and resolve issues causing payer payment delays Act cooperatively and courteously with patients, visitors, co-workers, management and clients. Maintain confidentiality at all times Maintain a professional attitude Understand and comply with Information Security and HIPAA policies and procedures at all times Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion

Requirements

High school diploma or equivalent required
3 years’ experience in Commercial insurance collections, including submitting and following up on claims
Experience in Hospital/Facility billing
Ability to work well individually and in a team environment.
Proficiency with MS Office
Strong communication skills/oral and written
Strong organizational skills
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
Detailed knowledge of Managed Care reimbursement methodologies
Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04

Responsibilities

Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
Perform payment variance analysis to identify trends in underpaid claims
Perform special projects and other duties as needed.
Identify and report underpayments and denial trends
Initiate appeals when necessary
Ability to analyze, identify and resolve issues causing payer payment delays
Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
Maintain confidentiality at all times
Maintain a professional attitude
Understand and comply with Information Security and HIPAA policies and procedures at all times
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion