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Payment Variance RC WMCG

Remote: 
Full Remote
Contract: 
Full time
Work from: 
United States

Offer summary

Qualifications:

High School Diploma or GED required., Minimum of 2 years of hospital collection experience required., Proficient understanding of healthcare payment processes and contractual agreements., Knowledge of HIPAA privacy standards and compliance practices..

Key responsabilities:

  • Research and analyze closed-balance accounts for payment discrepancies.
  • Contact payors to resolve payment issues and ensure proper documentation.
  • Monitor and report on payment accuracy and outstanding amounts to management.
  • Identify opportunities for process improvement and contribute to team goals.

Wellstar Health System logo
Wellstar Health System XLarge http://www.wellstar.org/
10001 Employees
See all jobs

Job description

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.

Job Posting

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.


 

A Brief Overview

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.


 

What you will do

  • 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.
    80%
  • 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 system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures.
    • Become cross-trained and fill in for other staff as assigned.
    10%
  • 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.
    5%
  • 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.
    5%
Qualifications
  • High School Diploma General Required and(
  • GED General Required or)
  • Minimum 2 years hospital collection experience Required
    Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.

    Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

    Required profile

    Experience

    Spoken language(s):
    English
    Check out the description to know which languages are mandatory.

    Hard Skills

    Payment ProcessingAccount ReconciliationRegulatory ComplianceContract ManagementMedical BillingAnalyticsClaims And Litigation ManagementProcess Improvement

    Other Skills

    • Professional Communication
    • Time Management
    • Teamwork
    • Problem Solving
    Are you interested?

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