Claims Variance Specialist
2 weeks ago
At SCP Health, your contributions are valued. As a member of the SCP Health team, you have the chance to impact healthcare positively.
With a vast network serving over 8 million patients, 7500 providers, across 30 states and 400 healthcare facilities, SCP Health excels in clinical practice management across the full spectrum of care, including emergency services, hospital care, wellness initiatives, telehealth, intensive care, and outpatient services.
Why you will appreciate working with us:
Proven history of promoting a healthy work/life balance
Comprehensive benefits and competitive salary
Dedication to nurturing an inclusive environment that emphasizes belonging and empowerment through our core values: collaboration, courage, agility, and respect.
Your responsibilities will include:
The Revenue Recovery Auditor will conduct retrospective evaluations of accounts compensated by commercial and/or governmental plans through data analysis.
Identify strategies to reclaim lost revenue due to underpayments, enhance reimbursement processes, and improve cash flow in compliance with federal and state regulations, third-party payer agreements, and UCR protections, which may involve engaging with payers to dispute claims.
Act as a liaison among Accounts Receivable, Administration, Operations, Systems, Underpayments team, and payers/plans, coordinating appeal efforts or resolutions across various departments within the Revenue Cycle.
Provide expertise or general assistance in reviewing, researching, investigating, negotiating, and resolving diverse appeals and grievances.Examine reimbursement data through both athena IDX Payor Contract Module (PCM) and custom reporting for payment accuracy, adjustments, and contract compliance.
Analyze and identify patterns in appeals and grievances; provide insights to management regarding false positives and genuine underpayment issues.Collaborate with payer/plans or other representatives to address inaccurate payment issues or non-compliance with contract stipulations; maintain consistent follow-up while keeping detailed, accurate, and concise records of communications with payers/plans.
Offer feedback to the Revenue Cycle regarding opportunities for improvement and appeal initiatives.Utilize payer portal websites, client patient account systems, and internal technologies to continuously verify activity, payment accuracy, and account status.
Assist in maintaining up-to-date information for all contracts in athena IDX Payor Contract Module (PCM), Salesforce database, and Crossmap.Maintain a thorough understanding of reimbursement regulations pertinent to assigned territories and/or plan types.
Ensure that company policies and procedures are current and accurately reflect processes to comply with regulatory standards.
What we seek:
Bachelor's degree or equivalent professional experience
1-3 years of prior experience in Managed Care, medical billing, and/or healthcare reimbursement
Ability to exercise significant individual judgment and initiative, relying on experience and judgment to achieve objectives.
Capability to perform under moderate stress and pressure while maintaining a positive, professional demeanor in person and through various communication channels.
Proficiency in delivering quality and timely results while managing multiple projects, demonstrating strong organizational and time management skills.Must collaborate effectively with others, exhibiting professional courtesy and excellent customer service skills.
Ability to communicate clearly and effectively, both verbally and in writing, with all levels of professionals, including executives.
Strong problem-solving skills, with the ability to collect and analyze complex data.
Ability to coordinate projects with diverse groups and individuals.
Competence in preparing and presenting effective reports.
Willingness to adhere to productivity targets and departmental guidelines.
Advanced understanding of healthcare reimbursement and state and federal insurance regulations.
Proficiency in Microsoft Office applications, particularly advanced Excel skills.
To learn more about SCP Health, please visit our website. SCP Health is an Equal Opportunity Employer.
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