Payment Variance Analyst

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

📋 Description

• Identify opportunities for additional reimbursement stemming from discrepancies in contractual payments.

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

• Report the root causes of identified payment discrepancies to management.

• Conduct payment variance analysis to uncover trends in underpaid claims.

• Request and compile payer-underpayment data in a standardized format for internal Payment Variance Specialists to validate.

• Analyze data and collaborate with Analytics and/or Pricing teams to address contract-load variances and generate accurate reports.

• Review client heat maps monthly for precision.

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

• Monitor the resolution and collection of underpaid claims.

• Escalate issues with payers or managed care teams for resolution and collection.

• Provide support and guidance to Payment Variance Specialists on various projects and assist the team as necessary.

• Initiate appeals when required.

• Track recurring patterns of underpayment and systemic issues.

• Analyze, identify, and rectify factors causing delays in payer payments, including billing and coding errors.

• Safeguard and disclose patients' PHI in accordance with HIPAA standards.

• Adhere to Information Security and HIPAA policies and procedures.

• Limit access to PHI to the minimum necessary to carry out assigned responsibilities.

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is required.

• 2 years of experience in commercial insurance collections, including the submission and follow-up on claims.

• 2 years of experience as an underpayment analyst.

• Comprehensive understanding of managed care reimbursement methodologies.

• Experience in hospital/facility billing.

• Ability to adapt to learning various systems and regulations.

• Proficiency in Microsoft Office Suite.

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

• Excellent problem-solving and creative skills, capable of exercising sound judgment and making decisions based on accurate and timely analyses.

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

• Exceptional written and verbal communication skills are required.

• Gracious and welcoming demeanor for customer service interactions.

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

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

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and career advancement.

• Flexible work schedules and a supportive work environment.