Payment Compliance Specialist

3 weeks ago

Franklin, United States SSC - Nashville Full time
Essential Duties and Responsibilities include the following:

  • Assist with the training of Analysts and Collectors
  • Identify trends in underpayment/overpayments, denials, revenue opportunities and revenue leakage
  • Evaluate trends and works towards resolution and improvement of revenue cycle processes
  • Interpret contract reimbursement and provide feedback to management staff as required
  • Manage underpayment appeals, account follow-up and payer relationships
  • Compile and analyze data to make recommendations
  • Work with financial and clinical departments collaboratively
  • Review contract validation, updates and interpretation
  • Resolve underpaid claims in an effective and timely fashion
  • Review payer policies for impact on reimbursement
  • Present data to various end users
  • Compile and validate account analysis prior to distribution
  • Research and identify payment discrepancies from various sources
  • Other duties as assigned
Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the education, experience, knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Highly organized
  • Initiative to work independently
  • Proficient with telephone and email communications
  • Excellent interpersonal skills required to communicate with direct staff and internal/external customers
  • Must possess excellent time management and organizational skills with great attention to detail
  • Maintain applicable continuing education requirements
  • The ability to work on multiple projects/initiatives at a time
Education/Experience/Skills:
  • High School graduate or equivalent
  • Minimum of 3 (three) years of hospital revenue cycle experience or equivalent work experience
  • Extensive experience of medical coding systems affecting the adjudication of patient accounts in EDI or UB04 form, including: ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures
Supervisory Responsibilities
  • Project Management including collaboration with senior management on matters where they may need to gain acceptance on an alternate approach with some latitude in decision making
  • Acts independently to determine methods and procedures when assigning team projects
Reasoning Ability:

The specialist must have the ability to define problems collects data, establish facts, and draw valid conclusions. The specialist must have the ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Computer Skills:To perform this job successfully, an individual should have:
  • Familiarity with relational database structure and some ability to use SQL or other query tool to access data directly from tables without programmer support
  • Interest and aptitude in computer-based applications for complex business processes involving Boolean expressions, symbolic representation and procedural logic
  • Required PC competencies including advanced Microsoft Office skills

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