Payment Variance Specialist

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary: The Payment Variance Analyst is responsible for ensuring that all claims are paid at contracted rates by researching and resolving payment variances for all applicable payers, with the goal of maximizing professional reimbursement for the services provided by WellStar Medical Group physicians. This position is responsible for understanding healthcare contracting terms and requirements in order to address underpayments and denials in accordance with regulatory and contractual obligations. This includes contract content review, application of appropriate contract terms and fee schedule(s), and a thorough understanding of the requirements of the Government and Non-Government payment policies & payer contracts. The Payment Variance Analyst will be responsible for identifying trends and reporting issues to the appropriate leadership for the purpose of enforcing Payer Contract Compliance. In addition, this position is held accountable to adhere to all policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works both independently and as a part of Payment Variance team, as well as with other teams in the WellStar Medical Group Business Office and throughout the health system. Core Responsibilities and Essential Functions: Payment Variance - Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department's policy and procedures. - Reviews historical payment information to determine accuracy of reimbursement. - Reviews potential payment variances and identifies true discrepancies. - Resolve payment disputes with payers by following appeal protocols and processes - Work closely by way of problem solving with peers and leaders to address payer underpayment and denial issues or changes that directly impact the accounts receivable. - Consistently utilize and accurately interpret various contracts. - Consistently identify and pursue collection of the money due on short-paid accounts; ensure all functions related to underpayments and denials support the team goals and objectives as well as WellStars financial performance objectives. - Verify overpaid accounts for appropriate payors and send to the Credits Refunds Specialists for review. - Consistently meet or exceed productivity standards, quality audits, targets, error ratios and reporting requirements as assigned by the department Manager. Management - Professional Development - Provide individual contribution to the overall team effort of achieving the department goals - 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 - Communicate in a professional manner with patients and representatives from third party payor organizations. - Communicate in a professional manner with provider relations, contract management, co-workers, and WellStar management. - 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 - Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements. 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 - Utilize assigned software applications. Report software application problems to the appropriate supervisor - Utilize assigned computer hardware. Report hardware problems to the appropriate supervisor - May be asked to participate in the testing for assigned software applications - Perform other duties and responsibilities as assigned Required Minimum Education: High school diploma Required or equivalent Required 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 Healthcare Revenue Cycle, Medical Billing or Health Insurance experience; Required and Healthcare Account Resolution and/or payment variance analysis experience Preferred Required Minimum Skills: Experience within a Physician Informational System or PC-based applications with the ability to perform mathematical calculations, understand payer policies, contracts and all applicable billing rules and regulations to facilitate decision making. Excellent communication / customer service skills will include oral, written comprehensive and expression when dealing with patients, families, public, co-workers and professional offices internal or external. Basic knowledge of medical terminology and PC applications are required; experience preferred. This position demands a detailed-oriented individual with good organization skills and the ability to be self-directed in order to complete continuous timelines. Strong time management skills are needed to manage multiple priorities with a heavy workload in a high-stressed atmosphere; including flexibility to perform other tasks as needed in an active work environment with the possibility of constant changing work needs. Ability and willingness to exhibit behaviors consistent with principles of excellent service in problem solving, analytical and investigational skills along with demonstrating and maintaining competency as required for this job title and the unit/area(s) of assignment. Capability to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect).

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