Reimbursement Variance Auditor

SCP Health • Lafayette, LA

1d

About The Position

At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care. Why you will love working here: - Strong track record of providing excellent work/life balance. - Comprehensive benefits package and competitive compensation. - Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect. SUMMARY: The Reimbursement Variance Auditor is to perform a retrospective review of accounts paid by managed care networks and/or governmental plans by data mining. The auditor will function as a liaison between A/R, Administration and Insurance carries by coordinating the appeal efforts across multiple departments within the Revenue Cycle.

Requirements

• Must be well organized and demonstrate effective time management skills
• Excellent communication skills for working with all different levels of professionals, including executives
• Must be detail oriented

Responsibilities

• Provide expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
• Perform third party contract reimbursement and utilization review for those policies and procedures related to the definition, identification and collection of denied or incorrect payments and management of denials of payment for the business office
• Reviews reimbursement data for accuracy of payments, adjustments and contract procedures
• Verify and compare reimbursement rates with existing fee schedules on file for accuracy
• Provides input and recommends improvement to existing fee schedules in an effort to maximize reimbursement, improve billing efficiency and reduce accounts receivable aging
• Provides guidance and/or assists billing representatives in the accounts receivable follow-up process.
• Analyze and identify trends for appeals and grievances
• Where appropriate, aggregates underpayment trends for expedited processing
• Provides feedback to manager regarding false positive and true underpayment issues
• Maintain appropriate fee schedules and request system setup
• Maintains a high level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with managed care companies
• Utilizes payer portal websites, client patient account systems, internal technology to continually validate activity, payment accuracy, and account status
• Communicate with appropriate parties issues, implications and decisions
• Liaison to billing companies, payers and other necessary parties; responsible for ensuring the correction of discoveries
• Maintain thorough knowledge of reimbursement regulations related to assigned region
• Provide feedback to Revenue Cycle related to improvement opportunities and appeal campaigns
• Ensures that company policies and procedures are current and accurately reflect processes in order to comply with regulatory requirements.
• Authority on impending reimbursement changes and current trends
• Identifies system or procedural problems creating third party claim rejections.
• Formulates and implements plans for minimizing or eliminating these rejections
• Assists in the performance contract reviews of third party payer agreements

Benefits

• Strong track record of providing excellent work/life balance.
• Comprehensive benefits package and competitive compensation.
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed