Payment Variance Analyst
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Job Description
Payment variance analyst identifying contractual underpayments and payer discrepancies for Med-Metrix. Analyzing claims, reimbursement methodologies, denials, and collections.
Responsibilities:
- Identify opportunities to pursue additional reimbursement due to contractual payment discrepancies
- Use managed care contracts to determine whether appropriate rates, provisions, and terms are being followed by payers
- Report root causes of payment discrepancies to the manager
- Perform payment variance analysis to identify trends in underpaid claims
- Request and prepare payer-underpayment data in a uniform format for internal Payment Variance Specialists to validate
- Analyze data and collaborate with Analytics and/or Pricing teams to resolve contract-load variances and produce accurate reporting
- Analyze client heat maps monthly for accuracy
- Identify and report underpayments and denial trends to client leadership
- Track resolution and collection of underpaid claims
- Escalate issues with payers or managed care teams for collection and resolution of underpaid claims
- Support and guide payment variance specialists on projects
- Initiate appeals when necessary
- Track recurring underpayment patterns and systematic issues
- Analyze, identify, and resolve issues causing payer payment delays, including billing and coding errors
- Use, protect, and disclose patients’ PHI in accordance with HIPAA standards
- Comply with Information Security and HIPAA policies and procedures
- Limit PHI access to the minimum necessary for assigned duties
- Perform other duties as assigned
Requirements:
- High school diploma or equivalent required
- 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 Hospital/Facility billing
- Ability to adapt to learning a wide range of systems and regulations
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills and ability to communicate well at all levels of the organization
- Strong problem solving and creative skills, with ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results orientation
- Excellent written and verbal communication skills required
- Gracious and welcoming personality for customer service interaction
- Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
- Ability to follow directions, collaborate with others, and handle stress
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