The Supervisor, Payment Variance is responsible for research, analysis, and resolution of payment variances for the purpose of improving revenue and cash performance. Optimize payer reimbursement and efficient A/R management.
Duties & Responsibilities
- Review and resolve credit balances through credit transfers, account corrections and refund request form completion for manual refund check requests
- Serve as a subject matter expert (SME) on payment variance workflows and processes
- Identifies root causes and trends contributing to patient and insurance credit balances and works collaboratively with all areas of the revenue cycle to improve efficiency and eliminate these issues
- Review refund and overpayment requests from insurance payers to determine if an overpayment has occurred
- Post approved debits for refunds
- Research returned checks and collaborates with A/P for reporting to unclaimed property
- Resolves Department credit balance inquiries for transfers and refund check requests
- Work collaboratively, building relationships with clinical areas and the payer community
- Understanding of electronic medical record / billing system Pricing Module and fee schedules
- Develop expertise with payer specialty-specific payment policies
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Review payments received from insurance payers to ensure adherence to contracted fee schedules
- Identify underpayment trends, determines root causes for discrepancies and provide feedback to leadership for enhancements
- Utilize electronic medical record / billing system Pricing Module and Contract Manager to monitor and evaluate billing and collection issues, providing detailed data and recommendations to management.
- Develops expertise with payer specialty-specific payment policies, by using the payer assigned websites.
- Interacts with insurance payers regarding claim payment issues.
- Assists in new hire training and building training materials
- Assists with reviewing and approving all refund requests
- Resolve escalated customer and client issues
- Conduct routine quality audits and maintains productivity reports
- Utilize reports for analysis and to monitor follow up activities and prioritization
- Assists organization with working through special projects as needed
- May assist in content building of training materials
- Perform special projects as required
Qualifications:
- BA/BS in health information management or related field
- 7+ years’ experience in health care/managed care environment, preferably in a large physician practice or a combination of experience and education
- Demonstrated ability to handle escalated client concerns
- Demonstrated capability to support/train/mentor other colleagues
- Expert in physician reimbursement and managed care claim payment issues
- Excellent communication skills and ability to effectively communicate with various levels of management in a multi-disciplinary environment
- Strong analytical skills with attention to detail
- Advanced level with Excel and financial analysis related to physician reimbursement
- Must be willing to work onsite in Ortigas
