United States onlyWith 150+ locations in 17 states, Qualderm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. At Qualderm we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you! Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care. We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees.
Position Summary
This role is responsible for analyzing and investigating discrepancies between expected payments and the actual amounts received, identifying the root causes of these variances, and taking corrective actions to ensure accurate financial reporting. This position must be able to work independently vetting payer policies, contract terms and payment methodologies to verify accuracy of underpayment variances. This position will be responsible for appropriately communicating with payers and management regarding contract compliance responsibilities and resolving reimbursement discrepancies.
Essential Responsibilities
- Analyze data to determine if claims were underpaid by contracts between QDP and third-party payer.
- Validate findings from business partner as it relates to potential payment variances.
- Monitor and verify payer contracts and fee schedules.
- Researching the reasons behind variances, including errors in coding, billing issues, payer rules changes, or system glitches.
- Understand how payer medical and reimbursement policies impact variances.
- Works with payer and business partner to resolve any payment variances.
- Ascertaining trends that emerge during account review and developing strategies to correct and collect on accounts.
- Able to relate and communicate positively, effectively, and professionally with others.
- Work calmly and respond courteously when under pressure.
- Collaborate and accept direction.
- Must be able to manage multiple assignments effectively including organizing and prioritizing workload.
- Problem solves as needed.
- Recall information with accuracy.
- Pay close attention to detail.
- Work independently with minimal supervision.
Requirements
- Associate degree or Bachelor's degree in Business, Finance or Accounting preferred
- Minimum 5+ years prior related healthcare Revenue Cycle experience in denials/underpayments.
- Experience with payment variance software and variance validation process required.
- Experience in Modernization Medicine Software is a plus.
- Strong Excel and Microsoft Office skills, including using advanced functions (VLOOKUP, HLOOKUP, INDEX, MATCH, etc.).
- Ability to read, understand and apply payer contracts/policies/protocols as it relates to expected reimbursement on a facility and professional claims.
- Ability to read and understand EOB details to validate if payments are reflected correctly on accounts.
- Must be knowledgeable in how billing scenarios such as place of service and modifiers impact reimbursement in order to accurately validate underpayment status.
- Clear understanding of the impact denials and underpayments have on Revenue Cycle operations and financial performance.
- Strong analytical, critical thinking and global thinking skills with the ability to identify common trends and causational problems.
- Approaches problems with an open mind and contributes to solutions.
- Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
- Excellent communication skills, both written and verbal.
- Must be located in one of the following states: AL, AZ, CA, DE, FL, GA, IL, IN, MD, MI, MN, MS, NC, NE, NJ, OH, OK, OR, PA, SC, TN, TX, VA, VT, WI, or WV.
Benefits
Benefits of joining Qualderm Partners:
- Competitive Pay – Attractive compensation to reward your hard work
- Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered
- Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
- Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year
- Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans
- Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances
- Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security
- Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges
- Exclusive Employee Discounts – Save on products and services with special discounts just for you
- Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team
QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States in a full-time basis.
