Payment Variance Representative, FT, Days, - Remote

Prisma Health; Columbia (SC); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare provider seeks a Claims Specialist to manage payment discrepancies and ensure compliance with contractual agreements. Responsibilities include analyzing claims, resolving inconsistencies, and collaborating across departments to optimize revenue cycle processes. The ideal candidate will have extensive experience in healthcare billing and be adept at using analytical tools.

Qualifications

• 5 years of experience in bookkeeping, invoice/account reconciliation or healthcare revenue cycle.
• CSPR, CRCR certifications preferred.

Responsibilities

• Ensures claims are paid according to contract agreements.
• Analyzes payments and processes appeals for discrepancies.
• Maintains knowledge of payor contract guidelines.

Skills

Superior written and oral communication skills

Excellent Microsoft Office Skills

Analytical skills

Critical thinking

Ability to work autonomously

Education

High School diploma or equivalent

Bachelor's degree (preferred)

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Ensures claims are paid appropriately pursuant to negotiated payment rates in Hospital's contractual agreements with all insurance payors. Evaluates and submits payment discrepancy disputes when appropriate.

Essential Functions

• Abides by all applicable policies, procedures, and guidelines of the Prisma Health System.

• Maintains knowledge of payor contract guidelines and resolves inconsistencies in payor compliance with contract terms, conditions, and rates.

• Analyzes payor payments and collaborates with other departments to process appeals and resolve appropriate underpayments. This includes application of appropriate contract terms, fee schedules, identification of trends, and reporting trends to management.

• Research insurance credit balances/adjustments to ensure accuracy of transactions and appropriate disbursement of funds due to insurance payors.

• Ensures timely follow-up and appropriate action for assigned accounts.

• Review payor refund requests to resolve reimbursement discrepancies. Initiates appeals or adjustments based on contract interpretation, payor policies and procedures.

• Meets productivity and quality standards according to departmental policy.

• Troubleshoots claim pricing in Prisma Health's Information Systems and offers suggestions for improvement.

• Makes recommendations regarding complexity of claim resolution and the appropriateness of transferring account to collection vendor(s) or other resources for follow-up.

• Works closely with team members and managementto participate and provide comprehensive training regarding appeals processing, process improvement, payor contracting and revenue cycle issues that impact reimbursement.

• Must adhere to all Prisma Health System Service Values.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned

• Experience - 5 years - Bookkeeping, invoice/account reconciliation or healthcare revenue cycle/medical office experience required. (Managed care, payor contracting & reimbursement, denials and/or appeals experience preferred.)

In Lieu Of

• Bachelor's degreewould substitute for three of the five years of required experience.

Required Certifications, Registrations, Licenses

• Certified Specialist Payment & Reimbursement (CSPR), Certified Revenue Cycle Representative (CRCR) or Certified Revenue Cycle Representative (CRCR) - Preferred

Knowledge, Skills, and Abilities

• Superior written and oral communication skills.

• Excellent Microsoft Office Skills, including the use of pivot tables and other functions in Excel.

• Strong critical thinking and analytical skills.

• Ability to work autonomously.

• Working knowledge of CPT and DRG coding practices.

• Ability to evaluate and prioritize workload.

• Ability to quickly problem solve and identify appropriate issues for escalation to management.

• Working knowledge of billing requirements for Government and Commercial Payors.

Work Shift

Day (United States of America)

Location

1200 Colonial Life Blvd

Facility

7001 Corporate

Department

70019012 Patient Account Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.