High school diploma or equivalent is required
1-2 years experience is required
The Payment Variance Specialist I is responsible for applying fundamental knowledge of billing, coding and payer requirements as it relates to researching, analyzing, and resolving denials, contractual underpayments and credits. This job requires regular outreach to payers and internal stakeholders.
Duties include, but are not limited to:
1. triaging incoming variance inventory
2. validating appeal criteria is met in compliance with departmental policies and procedures
3. composing technical denial language for reconsideration, including both written and telephonic
4. ensuring high level of competence in process and payer knowledge to overcome objections that prevent payment of the claim
5. gaining commitment for payment through concise and effective appeal composition
6. identifying problem accounts/processes/trends and escalate as appropriate
7. utilizing effective documentation standards that support a strong historical record of actions taken on the account
8. resolving the account (posting correct contractual adjustments, posting other non-cash related Explanation of Benefits (EOB) information, updating the patient accounts as appropriate
9. submitting uncollectible claims for adjustment timely and correctly
10. resolving claims impacted by payer recoupments, refunds, and posting errors
11. meeting and maintaining established departmental performance metrics for production and quality
12. maintaining working knowledge of workflow, systems, and tools used in the department
13. practicing and adhering to the Code of Conduct philosophy and Mission and Value Statement
14. maintaining collaborative approach to problem solving working with other revenue cycle teams and revenue generating areas
15. other duties as assigned
16. resolving accounts to 0 balance
Education and Experience:
1. High School diploma or equivalent
2. Two or more years of experience in health care billing functions
3. Ability to perform assigned tasks efficiently and in timely manner.
4. Ability to work collaboratively and effectively with people.
5. Exceptional communication and interpersonal skills.
6. Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail