Sr. Contract Variance Specialist - Business Office - Full Time - Days - 8hr

Emanate Health•Covina, CA

4d•$32 - $49•Onsite

About The Position

The Sr. Contract Variance Specialist works under the guidance of the Reimbursement Strategy Supervisor and is responsible for identifying payment variances at the account level based on expected reimbursement from contracted managed care payers, governmental payers, and non-contracted miscellaneous payers. This position serves as the contract language expert for multiple payers, ensuring accurate interpretation and application of reimbursement methodologies, contract terms, and payment provisions. The role reviews and validates proration calculations and adjustments, ensuring payments are allocated appropriately and in accordance with payer contracts, regulatory requirements, and organizational policies. The Sr. Contract Variance Specialist analyzes underpayments and identifies proration discrepancies, collaborates with Reimbursement Strategy Supervisor to resolve variance issues, and supports revenue recovery and reimbursement optimization efforts through detailed contract and reimbursement analysis. Ability to quickly learn and adapt to new systems, regulations, and payer requirements.

Requirements

High School diploma or equivalent required.
Minimum of seven to ten (7–10) years of experience in commercial insurance collections, including claims submission, follow-up, and appeals management.
Extensive knowledge of Managed Care reimbursement methodologies and hospital/facility billing processes.
Strong understanding of revenue cycle operations, including billing, collections, follow-up, payment posting, and reimbursement processes.
Experience interpreting payer contract language and applying various reimbursement and payment methodologies.
Demonstrated critical thinking and analytical skills with the ability to identify trends, resolve complex payment issues, and recommend process improvements.
Proficient in utilizing multiple billing and payer systems to analyze, compare, and communicate trends, discrepancies, and operational challenges.
Advanced proficiency in Microsoft Office Suite, particularly Excel.
Excellent customer service, verbal, and written communication skills.
Proven ability to work independently with minimal supervision while collaborating effectively in a team environment to achieve organizational goals and ensure optimal reimbursement outcomes.

Responsibilities

Identifying payment variances at the account level based on expected reimbursement from contracted managed care payers, governmental payers, and non-contracted miscellaneous payers.
Serving as the contract language expert for multiple payers, ensuring accurate interpretation and application of reimbursement methodologies, contract terms, and payment provisions.
Reviewing and validating proration calculations and adjustments, ensuring payments are allocated appropriately and in accordance with payer contracts, regulatory requirements, and organizational policies.
Analyzing underpayments and identifying proration discrepancies.
Collaborating with Reimbursement Strategy Supervisor to resolve variance issues.
Supporting revenue recovery and reimbursement optimization efforts through detailed contract and reimbursement analysis.
Quickly learning and adapting to new systems, regulations, and payer requirements.