Contract Variance Specialist

Job Overview:

The major responsibility of this position will be to identify payment variances at the account level based on expected reimbursement from contracted managed care payers, governmental payers and non-contracted miscellaneous payers. Knowledge and experience with revenue cycle, including the billing, follow up and payment processes, will be critical for success in this role, as well as experience with payer contract language and various payment methodologies. Knowledge of the Patient Access and/or HIM functions would also be helpful. Critical thinking skills, as well as the ability to identify trends and/or process improvement opportunities will be expected. This position will be the contract language expert for our many payers. To perform this role, working knowledge of various billing and payers systems will be required, as well as the ability to compare, analyze and communicate trends and/or problems is essential. This is a working position, meaning accounts identified to have a contract variance will be worked until payment as expected is received.

Job Requirements:

Associate's Degree or Diploma in Business, Healthcare, or other related field (Required)
3 - 4 years experience Professional Healthcare Revenue Cycle (Required)
Working knowledge of Epic Resolute, Excel, understanding of managed care contracts and payment terms 
Billing and Follow Up experience 
Patient Access and/or HIM knowledge

Job Responsibilities:

Actively seeks to resolve accounts using all resources and tools available (phone, electronic, payer, etc.). Consistently achieves and/or exceeds volume productivity while maintaining quaility and effective resolution practices. Addresses accounts by assigned payer in a expedient and effecitve manager. Minimum expectation is 210 accounts/weekly. 
Demonstrates knowledge of all systems and tools used to perform job functions, which may include any combination of multiple systems, including but not limited to: Epic, Availity, Florida Shared, WebMD, Passport, MedAssist Knowledge Base, On Base, payer websites, etc. Learns and follows corporate and department policies and procedures and workflows. Considered expert on payer contracts, medical policy and filing limitations. Becomes familiar with provider represenatives and utilizes him/her, payer websites and claim error spreadsheets regulary and effectively to get account resolution. Uses strong problem solving and analytical skills. 
Performs all aspects of job in a compliant and ethical manner. Docu 
Reports to work as scheduled and is engaged. Seen as a "go to" person within the larger team given knowledge and understanding of the larger revenue cycle process and payer contracts. Proactively communicates gaps to leadership and suggests solutions to identified problems. Shares information, participates in goal setting and actively participates in payer and/or workgroup meetings to promote process improvement.

Other Related Information:

Work Environment: Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports Requires lifting papers or boxes up to 25 pounds occasionally Work is performed in an office environment. Contact may involve dealing with angry or upset people Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations Able to effectively manage exposure to potentially infectious material per OSHA guidelines

Working Conditions:

Bending - 
Climbing - Rarely 
Concentrating - Consistently 
Continuous Learning - Frequently 
Hearing: Conversation - Consistently 
Hearing: Other Sounds - 
Interpersonal Communication - Consistently 
Kneeling - Occasionally 
Lifting Lifting 50+ Lbs. - Rarely 
Lifting Pulling - Rarely 
Pushing - Rarely 
Reaching - Rarely 
Reading - Consistently 
Sitting - Frequently 
Standing - Frequently 
Stooping - Rarely 
Talking - 
Thinking/Reasoning - Consistently 
Use of Hands - Consistently 
Color Vision - Frequently 
Visual Acuity: Far - 
Visual Acuity: Near - 
Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS... 
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello" 
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist 
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS... 
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met 
• Offer patients and guests priority when waiting (lines, elevators) 
• Work on improving quality, safety, and service

Respect: ALWAYS... 
• Respect cultural and spiritual differences and honor individual preferences. 
• Respect everyone's opinion and contribution, regardless of title/role. 
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS... 
• Value the time of others by striving to be on time, prepared and actively participating. 
• Pick up trash, ensuring the physical environment is clean and safe. 
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS... 
• Acknowledge wins and frequently thank team members and others for contributions. 
• Show courtesy and compassion with customers, team members and the community