Payment Variance Specialist

HealthPartners•Brainerd, MN

13h•$26 - $39

About The Position

The Payment Variance Specialist performs day-to-day payment variance activities, researching payment policies and reviewing potential payment variances on both facility and professional accounts. Serves as part of the Payment Variance team responsible for ensuring proper claims payments are received from insurance companies, determining root causes for discrepancies, minimizing inappropriate payment delays and variances from expected reimbursement, and resolving or escalating issues when necessary. This role will work with payers directly to ensure reimbursements are aligned with negotiated contracts. Use internal data and systems to identify, document, track and summarize payment variances to determine appropriate actions to be taken to initiate appeals and address inaccurate reimbursement in a timely manner.

Requirements

Minimum 3 years of experience in combined/comprehensive contract variance review/analysis, healthcare claims billing and/or collections, or any combination of experience listed.
Working knowledge of payer reimbursement methodologies.
Skilled in troubleshooting payment variances while reviewing payer policies related to reimbursement.
Excellent communication skills, both written and verbal that present clear and concise information to a diverse audience.
Strong accuracy, attention to detail and time management skills.
Advanced understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
Research and analytically oriented in work and analyses completed.
Ability to work well with ambiguity and continuous change.

Nice To Haves

5 years of healthcare experience specifically Epic workflow processes
Healthcare Financial Management Association (HFMA) – Certified Revenue Cycle Representative (CRCR)
Detailed knowledge of CPT-4, HCPCS, revenue codes and ICD-10 CM.
Knowledge of healthcare regulations and compliance requirements.
Demonstrated experience with administrative and clinical denial codes and appeal requirements.
Experience with Epic Denial workflows and work queue management.
Experience with large commercial payers and contracts.
Detailed knowledge of reimbursement schemes for predominant payors.

Responsibilities

Performs day-to-day payment variance activities.
Researches payment policies.
Reviews potential payment variances on both facility and professional accounts.
Ensures proper claims payments are received from insurance companies.
Determines root causes for discrepancies.
Minimizes inappropriate payment delays and variances from expected reimbursement.
Resolves or escalates issues when necessary.
Works with payers directly to ensure reimbursements are aligned with negotiated contracts.
Uses internal data and systems to identify, document, track and summarize payment variances.
Determines appropriate actions to be taken to initiate appeals and address inaccurate reimbursement in a timely manner.