Senior Contract Variance Analyst
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Job Description
Contract Variance Analyst Senior at Advocate Health overseeing underpayments management and appeals processing. Collaborating across departments to enhance revenue cycle and resolve payment discrepancies.
Responsibilities:
- Oversee the Hospital (HB) and Professional (PB) Underpayments Management process
- Serve as the liaison to management and for payer meetings/escalation to address contractual variance issues
- Optimize net revenue related to reimbursement for hospital and professional services including research and interpretation of payer regulations and contract language
- Provide key insights and recommendations to maximize net revenue within the current prevailing contract language for commercial/managed care and federal/state/ government contracts
- Provide guidance on contract payment discrepancies escalated by Variance Specialists
- Conduct quality reviews and monitor teammate productivity
- Recommend and update variance process flow documentation, policies, and procedures
- Provide training and serve as a super user for the department
- Adhere to Revenue Cycle guidelines for Adjustment Authorization approvals
- Ensure timely processing of appeals in accordance with payer /contract guidelines and Revenue Cycle policies
- Escalate appeals in process when necessary
- Advise on 2nd Level Appeal submissions
- Collaborate with departments such as Billing, HIM/coding, Case Management, and the medical team to obtain necessary medical documentation for underpayment appeals
- Provide status updates on high-dollar and/or aged accounts to management
- Identify, analyze, and research root causes and contract variance trends
- Develop and implement corrective action plans to resolve payment discrepancies
- Maintain reports identifying accounts affected by trends/root causes and ensure their resolution
- Monitor and report progress and resolution of trends, evaluating their financial impact on the Revenue Cycle
- Report new trends to management during weekly meetings
- Minimize internal inaccuracies causing false payment variances to increase revenue, streamline operations, and enhance the patient experience
- Identify and escalate operational issues to improve organizational performance
- Collaborate with Revenue Cycle Departments, Managed Health, Finance, and the Contract Build team to develop and implement corrective action plans to minimize preventable payment variances
- Ensure contractual allowances are accurate
- Communicate and escalate problematic variances, delays, and significant reimbursement issues to management, Managed Health, payers, and other stakeholders
- Compile and submit escalation reports for Payer/Department meetings
Requirements:
- Bachelor's Degree in Accounting, Health Care Administration or Equivalent Experience
- 6 years of Revenue Cycle or Managed Health experience related to payment resolution at a large hospital or integrated healthcare delivery system
- Excellent management and leadership skills
- Excellent communication, organizational and customer service skills
- Excellent and thorough knowledge of all aspects of the hospital revenue cycle as well as the supporting systems, reimbursement and governmental regulations and reimbursement models in effect
- Demonstrate high performance of leadership skills including ability to work well with others, team building, organizational, communication and presentation skills
- Ability to work collaboratively across disciplines
- Excellent process redesign skills
- Highly customer focused
- Ability to interpret and understand a Managed Care Contract
- Knowledge of medical terminology, UB-04 requirements and CPT, HCPCs Coding
- Strong knowledge of PCI compliance and how it pertains to the Health Care environment
- Demonstrate ability to react quickly to an ever-changing environment.
Benefits:
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Paid Time Off programs
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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