Reimbursement Variance Auditor

Description

At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

• Strong track record of providing excellent work/life balance
• Comprehensive benefits package and competitive compensation
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

What you'll be doing:

The Reimbursement Variance Auditor will be responsible for performing a retrospective review of accounts paid by commercial and/or governmental plans by data mining. Determine process to recover lost revenue related to underpayments, optimize reimbursement and cash flow in accordance with federal and state requirements, third party payer contracts and UCR protections which may include follow up with payers to appeal claims. Function as liaison between A/R, Administration, Ops, Systems, Underpayments team and payers / plans, coordinating appeal efforts or resolutions across multiple departments within the Revenue Cycle.

• Provide expertise or general support in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances.
• Review reimbursement data through both athena IDX Payor Contract Module (PCM) and ad hoc reporting for accuracy of payments, adjustments, and contract procedures.
• Analyze and identify trends for appeals and grievances; provide feedback to manager regarding false positive and true underpayment issues.
• Coordinate with payer / plan or other representatives to resolve inaccurate payment problems or lack of compliance with contract terms; maintain consistent follow-up while keeping thorough, accurate, and concise notes documenting communication with payers / plans.
• Provide feedback to Revenue Cycle related to improvement opportunities and appeal campaigns.
• Utilize payer portal websites, client patient account systems, and internal technology to continually validate activity, payment accuracy, and account status.
• Assist with maintaining current information for all contracts in athena IDX Payor Contract Module (PCM), Salesforce database and Crossmap.
• Maintain thorough knowledge of reimbursement regulations related to assigned territories and/or plan types.
• Ensure that company policies and procedures are current and accurately reflect processes to comply with regulatory requirements.

Who/What we are looking for:

• Bachelor's degree or equivalent work experience
• 1-3 years' previous Managed Care, medical billing, and/or healthcare reimbursement experience
• Ability to exercise considerable individual judgment and initiative, and to rely on experience and judgment to plan and accomplish goals.
• Ability to work under moderate stress and pressure while maintaining a positive, professional manner both in person and via phone, e-mail, business letter, or fax.
• Ability to produce quality and timely results while handling multiple projects, exhibiting good organizational and time management skills.
• Must work well with others, exhibiting professional courtesy and excellent customer relation skills.
• Ability to communicate clearly and effectively, both verbally and in writing with all levels of professionals, including executives.
• Ability to effectively problem solve, and to collect and analyze complex data.
• Ability to coordinate projects with diverse groups and individuals.
• Ability to prepare and explain effective reports.
• Willingness to adhere to productivity goals and departmental guidelines.
• Advanced understanding of healthcare reimbursement, and of state and federal insurance laws.
• Proficiency in Microsoft Office products, with advanced Excel skills.

To learn more about SCP Health, please visit:
www.scphealth.com

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SCP Health is an Equal Opportunity Employer.

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