Payment Variance Representative - FT - Days - Billing and Collection
Company: El Camino Health
Location: Mountain View
Posted on: July 30, 2022
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Job Description:
El Camino Health is committed to hiring, retaining and growing
the best and brightest professionals who will carry our mission and
vision forward. We are proud of our reputation in the community:
One built on compassion, innovation, collaboration and delivering
high-quality care. Come join the team that makes this
happen.FTE1Scheduled Bi-Weekly Hours80Work ShiftDay: 8 hoursJob
DescriptionThe Payment Variance Representative performs managed
care insurance payment audit/underpayment identification, research,
analysis, reporting, and collections functions. Ensures claims are
paid appropriately pursuant to negotiated payment rates in El
Camino Hospital s contractual agreements with managed care
insurance payers. Reports all significant underpayment issues,
trends, and systemic issues to Revenue Cycle Senior Management to
ensure there is no adverse effect on Hospital Cash Collections or
Accounts Receivable. Keeps informed of managed care and contractual
arrangements in order to resolve and process accounts by managed
care insurance payers. Follows up on all payment variances for
account resolution through insurance payer s online tools, phone
calls, and periodic in-person meetings with insurance payer
liaisons. Collaborates closely with the Contracting Services
Department to facilitate escalation of significant and systemic
insurance payment issues. Ensure all accounts are resolved in a
compliant manner and according to all applicable hospital
policies/procedures, rules, and regulations. After multiple
unsuccessful appeal attempts, the Payment Variance Representative
is tasked with carefully evaluating all factors and exercising
prudent decision making to determine whether to continue or cease
pursuit of insurance payment, subject to specific dollar
threshold(s) outlined in hospital policies and
procedures.QualificationsHigh School Diploma or equivalentMinimum
of five (5) years related work experience in a Hospital Billing
settingMinimum of three (3) years related work experience involving
interpretation/analysis of managed care contract payment
termsStrong critical thinking and analytical skillsStrong verbal
and written communication skillsProficient in HMO, PPO, Managed
Medicare, Managed Medi-Cal, and 3rd party rules and
regulationsProficient in managed care contracting payment terms and
rate structures for hospitalsWorks in a collaborative and team
mannerBasic to intermediate skill level in Microsoft Excel
(Microsoft Access is a plus)The Physical Requirements and Working
Conditions of this job are available. El Camino Health will provide
reasonable accommodations to qualified individuals with a
disability if that will allow them to perform the essential
functions of a job unless doing so creates an undue hardship for
the hospital, or causes a direct threat to these individuals or
others in the workplace which cannot be eliminated by reasonable
accommodation.Sedentary Work - Duties performed mostly while
sitting; walking and standing at times. Occasionally lift or carry
up to 10 lbs. Uses hands and fingers. - (Physical
Requirements-United States of America)An Equal Opportunity
Employer:El Camino Health seeks and values a diverse workforce. The
organization is an equal opportunity employer and makes employment
decisions on the basis of qualifications and competencies. El
Camino Health prohibits discrimination in employment based on race,
ancestry, national origin, color, sex, sexual orientation, gender
identity, religion, disability, marital status, age, medical
condition or any other status protected by law. In addition to
state and federal law, El Camino Health also follows all applicable
fair and equitable employment policies from the County of Santa
Clara.
Keywords: El Camino Health, Mountain View , Payment Variance Representative - FT - Days - Billing and Collection, Accounting, Auditing , Mountain View, California
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