Payment Variance RC

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Work Shift

Job Summary:

The Contract Variance Analyst researches closed-balance accounts for over/under amounts due from/to payors per established contracts. The Specialist ensures payments are made properly and in full per contractual agreements identifying and reporting payor trends thru established guidelines. This position also coordinates; transfers and communication of accounts with insurance balances to the appropriate outside agency, per department guidelines.

Core Responsibilities and Essential Functions:

Job Functions

- Perform daily, systematic reviews of $0 balance accounts for the appropriate contractual reimbursement.
- Post adjustments at time of account review.
- Contact identified payor sources to resolve problems or issues with payment release.
- Transmit required documentation to Third Party Payors for the purpose offor resolving payments.
- Ensure all payor contact is fully documented in the appropriate software application.
- Monitor payments for accuracy, contacting payors to resolve outstanding amounts and reporting ongoing problem and issues with the department Manager
- Utilize industry and regulatory guidelines for collection of outstanding accounts.
- Consistently utilize and accurately interpret various contracts.
- Consistently identify and pursue collection of the money due on short-paid accounts.
- Refer overpaid accounts to the Credit and Refund Specialists for review.
- Consistently meet the current productivity standards in ensuring payments are made properly and in full per contractual agreements.
- Consistently meet the current quality standards in ensuring payments are made properly and accurately.
- Meet productivity standards, targets, error ratios and reporting requirements as assigned by the department Manager or Supervisor. Management - Professional Development
- Provide individual contribution to the overall team effort of achieving the department AR goal.
- Identify opportunities for system and process improvement and submit to management.
- Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.
- Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices.
- Follow the health systems general Policy and Procedures, the Departments Policy and Procedures, and the Emergency Preparedness Procedures.
- Become cross-trained and fill in for other staff as assigned. Professional Communication
- Assure patient privacy and confidentiality as appropriate or required.
- Ensure minors have a parent or guardian listed as guarantor as appropriate.
- Communicate in a professional manner with patients, their families and representatives from third party payor organizations.
- Communicate in a professional manner with physicians, physician staff, co-workers, management and clinical staff.
- Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
- Initiate communication with peers about changes and procedures.
- Relay information appropriately over telephone, email, and other communication devices.
- Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives. Department Methods/Procedures/Operations
- Follow department guidelines for lunch, breaks, requesting time off, and shift assignments.
- Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies.
- Follow JCAHO and outside regulatory agencies mandated rules and procedures.
- Utilize assigned menus and pathways in the hospital mainframe system. Report software application problems to the appropriate supervisor.
- Utilize assigned menus and pathways in foreign software applications. Report software application problems to the appropriate supervisor.
- Utilize assigned computer hardware. Report hardware problems to the appropriate supervisor.
- Participate in the testing for assigned software applications, including verification of field integrity.
- Perform other duties and responsibilities as assigned.

Required Minimum Education:

• High School Diploma General or GED General

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 2 years hospital collection experience Required

Required Minimum Skills:

Demonstrate proficiency in reading UB04.

Demonstrate knowledge and proficiency of claims resolution.
Demonstrate ability to access Major payer(s) specific provider websites for claim corrections.
Demonstrate proficiency in locating and interpreting contract verbiage for timely claims resolution.
Demonstrate proficiency in contract management and expected reimbursement technology.
Demonstrate knowledge of billing rules.
Two years experience with a Hospital Information System or PC-based applications.
Ability to perform mathematical calculations.
Excellent communication skills when dealing with patients, families, public, and co-workers.
Basic knowledge of medical terminology.
Detail-oriented, good organizational skills, and ability to be self-directed.
Ability to learn quickly and meet continuous timelines.
Strong time management skills, managing multiple priorities and workload in a high-stress atmosphere.
Demonstrated flexibility to perform other tasks as needed in an active work environment.
High-level problem solving, analytical, and investigational skills.
Excellent internal/external customer service skills.
Excellent communication skills to include oral and written comprehension and expression.
Ability and willingness to exhibit behaviors consistent with principles of excellent service.
Ability to demonstrate and maintain competency as required for job title and area(s) of assignment.

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