Payment Variance Analyst

JOB SUMMARYThe Payment Variance Analyst is responsible for the identification and the pursuit of additional reimbursement due Hamilton Health Care System related to contractual payment discrepancies. This position will make use of managed care contracts to determine appropriate rates, provisions and terms are followed by payers. Researches underpayments by insurance payers and aggressively pursues and overturn unidentified underpayments from these payers with timeliness and accuracy. Analyze and interpret complex managed care contracts, provider requirements and payment methodologies for hospital-based and/or physician-based reimbursement. Responsible for investigating and addressing overpayment and underpayment accounts with the objective of appropriately optimizing reimbursement for services rendered. Negotiates and insist accountability with third party payers on accounts through follow-up with accuracy and timeliness. Utilize all available resources (on-line websites, contract management software) to aid in the expedient recovery of underpaid accounts. Performs payment variance analysis to identify trends in underpaid claims. Reports any root causes for payment discrepancies to management.

Education: High School diploma or equivalentLicensure: N/AExperience: Four plus years’ experience in a healthcare collections or managed care environment. Experience working with health care insurance carriers; or Associate’s degree with 2 years’ experience in healthcare collections or a managed care environment. Skills: Excellent interpersonal and organizational skills. Ability to receive and express detailed information through oral and written communication. Proficient at Microsoft Office (Email, Word, Excel). Working knowledge of managed care terminology, managed care reimbursement.