Variance Analyst Reimbursement Managed Care - Remote

Day (United States of America)

900 HOPE WAY

ALTAMONTE SPRINGS

Florida

32714

Demonstrated 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 Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables Submits credentialing reports accurately and timely. Confirms provider information on credentialing applications and reports. Enters effective date and provider number information from payers into relevant systems. Reviews and resolves claim denials related to credentialing and enrollment status. Identifies and analyzes payment variances for professional fee contracts and government payers. Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules. Liaises with payers to address issues and ensure accurate processing. Works closely with Managed Care contract administration to ensure accurate provider profiles. Maintains knowledge of current rules and regulations of Commercial and Government programs. Aggregates and categorizes variance types for management review. Serves as a resource for payment variance identification and education. Coordinates with billing support teams on identified payment variances and credentialing denials. Other duties as assigned.Knowledge, Skills, and Abilities:
• In-depth knowledge of Commercial and Government program reimbursement rules and regulations [Required]
• Ability to research and interpret Commercial and Government payer rules and regulations [Required]
• Proficient in the use of payment variance software and tools [Required]
• Proficient understanding of variance reimbursement methodologies, auditing principles, and their application to healthcare [Required]
• Ability to learn new technology applications [Required]
• Excellent interpersonal skills [Required]
• Well-organized and detail-oriented with the ability to give attention to detail and accuracy [Required]
• Ability to complete assigned tasks with limited supervision [Required]
• System experience in identifying payment variances (Athena/Epic) [Preferred]
• Claim denial follow-up with payers [Preferred]
• Ability to identify process improvement opportunities and manage priorities to accomplish project deadlines and department goals [Required]
• Must demonstrate an ability and willingness to learn and adapt to a constantly changing reimbursement environment [Required]
• Independent decision-making required to determine the best method to complete assigned tasks [Required]

Education:
• Bachelor's [Preferred]
• High School Grad or Equiv [Required]

Field of Study:
• Healthcare business [Preferred]

Work Experience:
• 3+ relevant experience in healthcare reimbursement including commercial and government payers [Required]

Additional Information:
• N/A

Licenses and Certifications:
• N/A

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677

$45,196.93 - $84,071.39