Job Purpose

The Payment Variance Analyst will identify opportunities to pursue additional reimbursement due to contractual payment discrepancies. This role will make use of managed care contracts to determine appropriate rates, provisions and terms are being followed by the payers. The Payment Variance Analyst will report any root causes for the discrepancies identified to the manager.

The Payment Variance team is responsible for collecting outstanding reimbursements left due to contractual discrepancies and insurance payer underpayments.

Duties & Responsibilities

• Perform payment variance analysis to identify trends in underpaid claims
• Request and prepare data for payer underpayments in uniformed fashion to send to internal Payment Variance Specialists for complete validation
• Analyze data and work with Analytics and/or Pricing teams to resolve contract load variances and produce accurate reporting
• Monthly analyze client heat maps for accuracy
• Identify and report underpayments and denial trends to client leadership and track for resolution and collections of underpaid claims
• Perform escalations with payers or managed care teams for collection and resolution of underpaid claims
• Provide support and guidance to payment variance specialists on projects and support the team as needed
• Initiate appeals when necessary
• Track reoccurring underpayment patterns and systematic issues
• Analyze, identify and resolve issues causing payer payment delays including billing and coding errors
• Other duties as assigned

Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Understand and comply with Information Security and HIPAA policies and procedures at all times. Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Qualifications

• High school diploma or equivalent required
• 2 years’ experience in Commercial insurance collections, including submitting and following up on claims
• 2 years’ experience of underpayment analyst experience
• Detailed knowledge of Managed Care reimbursement methodologies
• Experience in Hospital/Facility billing
• Ability to adapt to learning a wide range of systems and regulations
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.