Responsible for identifying payment variances for professional fee commercial contracts and government payers. Reviews reports generated by Athena and/or PED to determine of the variances listed in the report, which are the true variances (under/overpayments) based on reimbursement guidelines from past billing/payer experience, payer websites, government updates, contracted fee schedules, etc.
Liaisons with payer as directed by management to request payment and/or within given guidelines, negotiates/approves discount.
Closely works with MC contract administration and keeps open dialogue to ensure loaded contracts are accurate and updated as directed by management.
Maintains a working knowledge of current rules and regulations of Commercial and Government programs.
Reviews contractual adjustments to determine cause, aggregates and categorizes variances types in organized manner for management review.
Serve as Adventist Health Systemâ™s subject matter resource for Commercial and Government payment variance identification, and education.
Meets with PE and MC as directed by management to update current variance projects and specific payer issues.
Analyzes data to provide payer reimbursement trends
Coordinates with billing support teams as directed by management on identified payment variances.
Completes special projects as assigned by the reimbursement manager within the time frame requested.
What You Will Need:
High school or equivalent degree
Minimum of 3 years of relevant experience in healthcare reimbursement including Commercial and Government payers
In depth knowledge of Commercial and Government program reimbursement rules and regulations
Ability to research and interpret Commercial and Government payer rules and regulations
Proficient in use of payment variance software
Possess an understanding of variance reimbursement methodologies, auditing principles and their application to healthcare
Strong computer software skills including Microsoft Office applications
Ability to learn new technology applications used by Adventist Health System
Strong analytical reasoning, critical thinking, judgment and problem solving skills in order to independently assess, interpret and address complex issues in a continually changing environment
Excellent interpersonal skills
Well organized and detail-oriented
Ability to complete assigned tasks with limited supervision
Responsible for evaluating professional fee contractual adjustments for accuracy in accordance with various payer contracts and/or federally mandated guidelines. This position supports the payment variance identification for the Physician Enterprise (PE) and works closely with practice office operations staff, Managed Care (MC) contracting and billing support teams to identify and recommend corrective action on payment variances.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.