The Payment Variance Specialist is responsible for identifying patient accounts with underpayments and overpayments. Upon review of such patient accounts, this specialist is expected to review patient accounts and appropriately communicate with payors regarding contract compliance responsibilities and resolve reimbursement discrepancies.
1. Review accounts to ensure that the account balance and payment is accurate and verify that all correct steps have been taken.
2. Work with PMMC, contractual proration tool, to determine remaining variances are truly categorized as a potential underpayments and overpayments.
3. Review accounts to ensure that no billing / claim errors have occurred and the balance on the account is correct.
4. Verify contracted rates with contracted payor and compare them with the insurance payment.
5. Identify and escalate variances to the Supervisor of Payment Discrepancy Unit for review.
6. Document all account activity on each account through descriptive account notes
7. Initiate appropriate collection letters on patient liability.
8. Accumulate, prepare, and analyze data necessary for contract compliance of HMO and PPO plans.
9. Adhere to all DeKalb Medical Center policies and procedures.
10. Participate in continuous quality improvement activities and teams.
11. Participate in supporting the organization’s vision, mission and values and adheres to DeKalb Medical Standards of Behavior.
12. Perform other duties as assigned to meet the goals and objectives of DeKalb Medical.
Minimum Education, Experience and Licensure Required:
· High School Diploma.
· Three (3) years job related experience in hospital Business Office or Central Business Office (CBO).
· Working experience with medical terminology
· Working experience with data spreadsheets
Skills, Knowledge and Abilities:
· Proficiency in Microsoft Office products (e.g. Word, PowerPoint, and Excel)
· Demonstrates understanding of medical terminology
· Knowledge of CPT, HCPCS, ICD-10 coding procedures
· Good communications skills, both written and oral
· Knowledge of medical billing and collection practices
· In-depth working knowledge of Government, Commercial and Managed Care insurance carriers
· Performs skills and competencies as defined in orientation checklist and annual departmental competency checklist if applicable.
· Demonstrates and maintains competencies specific to patient population served.
Reports to: Supervisor of Payment Variance