Job Purpose The Payment Variance Specialist II performs research, analysis, and resolution of payment variances for the purpose of improving revenue and cash performance.
This role focuses on optimizing payer reimbursements to create effective and efficient A/R management.
Duties Responsibilities Reviews and resolves credit balances through credit transfers, account corrections, and refund request form completion for manual refund check requests.
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.
Reviews refund and overpayment requests from insurance payers to determine if an overpayment has occurred.
Posts debits for approved refunds.
Researches returned checks and collaborates with A/P for reporting to unclaimed property.
Resolves department credit balance inquiries for transfers and refund check requests.
Works collaboratively and builds positive business relationships with clinical areas and the payer community.
Develops expertise with payer specialty-specific payment policies by using the payer assigned websites.
Maintains and respects the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure.
Reviews payments received from insurance payers to ensure adherence to contracted fee schedules.
Identifies underpayment trends and determines root causes for discrepancies and provides feedback to management.
Utilizes 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.
Interacts with insurance payers regarding claim payment issues.
Performs special projects as required.
Qualifications Competencies BA/BS in accounting, business, finance or an equivalent combination of training and experience.
5 years+ in health care/managed care environment, preferably in a large physician practice.
Intermediary knowledge of physician reimbursement and managed care claim payment issues.
Excellent verbal and written communication skills and ability to effectively communicate with various levels of management in a multi-disciplinary environment.
Understanding of electronic medical record/billing system Pricing Module and fee schedules.
Strong analytical skills with attention to detail.
Advanced level with Excel and financial analysis related to physician reimbursement.
Ability to do math calculations, input data into the computer, and analyze data as requested.
Must be willing to work onsite in Ortigas, Pasig City.
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