Payment Variance Analyst

Job Purpose

The Payment Variance Analyst will identify opportunities to pursue additional reimbursement due to contractual payment discrepancies. This role will make use of managed care contracts to determine appropriate rates, provisions and terms are being followed by the payers. The analyst will report any root causes for the discrepancies identified to the manager.

The Team is responsible for collecting outstanding reimbursements left due to contractual discrepancies and insurance payer underpayments.

Duties and Responsibilities

• Perform payment variance analysis to identify trends in underpaid claims
• Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
• Identify and report underpayments and denial trends
• Initiate appeals when necessary
• Analyze, identify and resolve issues causing payer payment delays including billing and coding errors
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
• Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion

Qualifications

• 2 years’ experience in Commercial insurance collections, including submitting and following up on claims
• 2 years’ experience of underpayment analyst experience
• Detailed knowledge of Managed Care reimbursement methodologies
• Experience in Provider billing
• Ability to adapt to learning a wide range of systems and regulations
• Ability to work well individually and in a team environment
• Proficiency with MS Office
• Strong communication skills, including oral and written
• Strong organizational skills

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.