Posted in Other about 24 hours ago.
Facility: VIRTUAL-GA
Job Summary: The Contract Variance Analyst researches closed-balance accounts for over/under amounts due from/to payors per established contracts. The Specialist ensures payments are made properly and in full per contractual agreements identifying and reporting payor trends thru established guidelines. This position also coordinates; transfers and communication of accounts with insurance balances to the appropriate outside agency, per department guidelines. Core Responsibilities and Essential Functions: Job Functions - Perform daily, systematic reviews of $0 balance accounts for the appropriate contractual reimbursement. - Post adjustments at time of account review. - Contact identified payor sources to resolve problems or issues with payment release. - Transmit required documentation to Third Party Payors for the purpose offor resolving payments. - Ensure all payor contact is fully documented in the appropriate software application. - Monitor payments for accuracy, contacting payors to resolve outstanding amounts and reporting ongoing problem and issues with the department Manager - Utilize industry and regulatory guidelines for collection of outstanding accounts. - Consistently utilize and accurately interpret various contracts. - Consistently identify and pursue collection of the money due on short-paid accounts. - Refer overpaid accounts to the Credit and Refund Specialists for review. - Consistently meet the current productivity standards in ensuring payments are made properly and in full per contractual agreements. - Consistently meet the current quality standards in ensuring payments are made properly and accurately. - Meet productivity standards, targets, error ratios and reporting requirements as assigned by the department Manager or Supervisor. Management - Professional Development - Provide individual contribution to the overall team effort of achieving the department AR goal. - 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. - Ensure minors have a parent or guardian listed as guarantor as appropriate. - Communicate in a professional manner with patients, their families and representatives from third party payor organizations. - Communicate in a professional manner with physicians, physician staff, co-workers, management and clinical staff. - 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. 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. - Follow JCAHO and outside regulatory agencies mandated rules and procedures. - Utilize assigned menus and pathways in the hospital mainframe system. Report software application problems to the appropriate supervisor. - Utilize assigned menus and pathways in foreign software applications. Report software application problems to the appropriate supervisor. - Utilize assigned computer hardware. Report hardware problems to the appropriate supervisor. - Participate in the testing for assigned software applications, including verification of field integrity. - Perform other duties and responsibilities as assigned. Required Minimum Education:
Slalom, LLC |
OLDCASTLE INFRASTRUCTURE, INC. |
Doyon Government Group |