Payment Variance Analyst

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Identify opportunities to seek additional reimbursement due to discrepancies in contractual payments.

• Utilize managed care contracts to assess whether the appropriate rates, provisions, and terms are adhered to by payers.

• Report the root causes of payment discrepancies to the manager.

• Conduct payment variance analyses to identify trends in underpaid claims.

• Request and prepare payer underpayment data in a standardized format for internal Payment Variance Specialists to verify.

• Analyze data and collaborate with the Analytics and/or Pricing teams to address contract-load variances and produce precise reporting.

• Review client heat maps monthly to ensure accuracy.

• Identify and report underpayment and denial trends to client leadership.

• Monitor the resolution and collection of underpaid claims.

• Escalate issues with payers or managed care teams to facilitate the collection and resolution of underpaid claims.

• Provide support and guidance to payment variance specialists on various projects.

• Initiate appeals when necessary.

• Track recurring patterns of underpayment and systematic issues.

• Analyze, identify, and resolve issues leading to delays in payer payments, including billing and coding errors.

• Use, protect, and disclose patients’ PHI in compliance with HIPAA standards.

• Adhere to Information Security and HIPAA policies and procedures.

• Limit access to PHI to the minimum necessary for assigned responsibilities.

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is required.

• Minimum of 2 years’ experience in commercial insurance collections, including submitting and following up on claims.

• At least 2 years’ experience as an underpayment analyst.

• Comprehensive knowledge of managed care reimbursement methodologies.

• Experience in hospital/facility billing.

• Ability to adapt to learning a wide range of systems and regulations.

• Proficiency in Microsoft Office Suite.

• Strong interpersonal skills with the ability to communicate effectively at all levels of the organization.

• Excellent problem-solving and creative skills, with the capacity to exercise sound judgment and make decisions based on accurate and timely analyses.

• High level of integrity and dependability, coupled with a strong sense of urgency and results orientation.

• Outstanding written and verbal communication skills are essential.

• Friendly and welcoming demeanor for customer service interactions.

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

• Ability to follow directions, collaborate with others, and manage stress effectively.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Opportunities for professional development and advancement.

• Flexible work schedule and remote work options.