Payment Variance Representative, FT, Days, - Remote

Job description

Inspire health. Serve with compassion. Be the difference. Job Summary: Ensures claims are paid appropriately pursuant to negotiated payment rates in Hospital’s contractual agreements with all insurance payors. Evaluates and submits payment discrepancy disputes when appropriate. Essential Functions: Abides by all applicable policies, procedures, and guidelines of the Prisma Health System. Maintains knowledge of payor contract guidelines and resolves inconsistencies in payor compliance with contract terms, conditions, and rates. Analyzes payor payments and collaborates with other departments to process appeals and resolve appropriate underpayments. This includes application of appropriate contract terms, fee schedules, identification of trends, and reporting trends to management. Research insurance credit balances/adjustments to ensure accuracy of transactions and appropriate disbursement of funds due to insurance payors. Ensures timely follow-up and appropriate action for assigned accounts. Review payor refund requests to resolve reimbursement discrepancies. Initiates appeals or adjustments based on contract interpretation, payor policies and procedures. Meets productivity and quali...