Payment Variance Spec

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Exemption Status

Non-Exempt

Schedule Details

Monday through Friday

Scheduled Hours

8 hour shift between 6a-5p

Shift

1 - Day Shift, 8 Hours (United States of America)

Hours

40

Cost Center

99940 - 5416 Payment Variance and Contracts

Union

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsible for processing payment discrepancies (under/overpayments). Reviews, analyzes and initiates appropriate action for discrepancy resolution.

I. Major Responsibilities

• Prioritizes standards and guidelines to perform payment variance follow up utilizing assigned work queue.
• Analyzes and researches overpayments and underpayments with payers. Determines and executes the best approach for resolution.
• Validates payment discrepancies using Hospital Billing Revenue Cycle management system calculations. Identifies and isolates payment variance trends and discrepancies, escalates as appropriate.
• Corresponds with third party payers, hospital departments, and patients to obtain information required for payment variance resolution. Clearly documents all actions taken during the resolution process.
• Applies reimbursement concepts while researching and triaging payment variance.
• Troubleshoots payer issues and increase understanding of payment variance resolution techniques utilizing reference material. References payer websites as needed.
• Analyzes and manages outstanding credit balances and resolves through posting corrections, refunds, and retraction requests. Identifies coordination of benefits variances and appropriately identifies primary payer.
• Updates account insurance information as needed to allow correct recalculation, resolving the variance and escalates trends.
• Adjusts account balances using correct transaction, code adhering to guidelines.
• Submits appeals utilizing payers preferred method, i.e., electronically or via paper.
• Maintains current knowledge of payer payment policies, changes, and revisions. Utilizes payer websites to research payer payment policies.
• Remains current on basic coding principles (i.e. modifiers). Understands billing requirements.
• Meets established productivity standards.
• Participates in cross training to optimize resources.
• Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
• Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
• Maintains and fosters an organized, clean, and safe work environment.
  
  

Standard Staffing Level Responsibilities

• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.
  
  

II. Position Qualifications

All responsibilities are essential job functions.

License/Certification/Education

Required:

• High School diploma
  
  

Experience/Skills

Required:

• Two or more years of experience in health care billing functions.
• Knowledge and experience with health care revenue cycle systems and billing tools.
• Proven track record of successful performance and goal achievement.
• Ability to perform assigned tasks efficiently and in timely manner.
• Ability to work collaboratively and effectively with people.
• Exceptional communication and interpersonal skills.
  
  

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands And Environmental Conditions

Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [email protected]. We will make every effort to respond to your request for disability assistance as soon as possible.