Payment Variance Specialist
About The Position
At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for processing payment discrepancies (under/overpayments). Reviews, analyzes and initiates appropriate action for discrepancy resolution.
Requirements
- High School diploma
- Two or more years of experience in health care billing functions.
- Knowledge and experience with health care revenue cycle systems and billing tools.
- Proven track record of successful performance and goal achievement.
- Ability to perform assigned tasks efficiently and in timely manner.
- Ability to work collaboratively and effectively with people.
- Exceptional communication and interpersonal skills.
Responsibilities
- Prioritizes standards and guidelines to perform payment variance follow up utilizing assigned work queue.
- Analyzes and researches overpayments and underpayments with payers. Determines and executes the best approach for resolution.
- Validates payment discrepancies using Hospital Billing Revenue Cycle management system calculations. Identifies and isolates payment variance trends and discrepancies, escalates as appropriate.
- Corresponds with third party payers, hospital departments, and patients to obtain information required for payment variance resolution. Clearly documents all actions taken during the resolution process.
- Applies reimbursement concepts while researching and triaging payment variance.
- Troubleshoots payer issues and increase understanding of payment variance resolution techniques utilizing reference material. References payer websites as needed.
- Analyzes and manages outstanding credit balances and resolves through posting corrections, refunds, and retraction requests. Identifies coordination of benefits variances and appropriately identifies primary payer.
- Updates account insurance information as needed to allow correct recalculation, resolving the variance and escalates trends.
- Adjusts account balances using correct transaction, code adhering to guidelines.
- Submits appeals utilizing payers preferred method, i.e., electronically or via paper.
- Maintains current knowledge of payer payment policies, changes, and revisions. Utilizes payer websites to research payer payment policies.
- Remains current on basic coding principles (i.e. modifiers). Understands billing requirements.
- Meets established productivity standards.
- Participates in cross training to optimize resources.
- Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
- Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
- Maintains and fosters an organized, clean, and safe work environment.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
