Contract Variance Analyst Senior

Department:

Status:

Benefits Eligible:

Hou rs Per Week:

Schedule Details/Additional Information:

Full time, Day Shift Monday - Friday

Pay Range

Major Responsibilities:

Underpayments Management : Oversee the Hospital (HB) and Professional (PB) Underpayments Management process.Serve as the liaison to managementand forpayer meetings/escalation to address contractual variance issues. Optimizenet revenue related to reimbursement for hospital and professional services including research and interpretation of payer regulations and contract language.Provide key insights and recommendations to maximize net revenue within the current prevailing contract language for commercial/managed care and federal/state/ government contracts.Provide guidance oncontractpayment discrepancies escalated by Variance Specialists.Conduct quality reviews andmonitorteammate productivity.Recommend and update variance processflowdocumentation, policies, and procedures. Provide training and serve as a super userfor the department.Adhere to Revenue Cycle guidelines for Adjustment Authorization approvals.

Appeals Processing : Ensuretimelyprocessing of appealsin accordance withpayer/contractguidelines and Revenue Cycle policies. Escalate appeals in process when necessary.Advise on2nd Level Appeal submissions. Collaborate with departments such as Billing, HIM/coding, Case Management, and the medical team to obtain necessary medical documentation for underpayment appeals. Provide status updates on high-dollar and/or aged accounts to management.

Payment Variance Analysis :Identify, analyze, and research root causes andcontract variancetrends. Develop and implement corrective action plans to resolvepayment discrepancies.Maintainreportsidentifyingaccounts affected by trends/root causes and ensure their resolution. Work with internal and external partners to minimize preventable underpayments. Monitor and report progress and resolution of trends, evaluating theirfinancial impacton the Revenue Cycle. Reportnew trendsto management during weekly meetings.Refer insurance and patient refunds to the Refund Team.

Operational Accuracy and Improvement : Minimize internal inaccuracies causing false payment variances to increase revenue, streamline operations, and enhancethe patientexperience.Identifyand escalate operational issues to improve organizational performance. Collaborate with Revenue Cycle Departments,Managed Health, Finance, and the ContractBuildteam to develop and implement corrective action plans to minimize preventable payment variances.Ensure contractual allowances areaccurate.Work with managementtoimplement changes to address internal process flow deficiencies.

Communication and Escalation : Communicate and escalate problematic variances, delays, and significant reimbursement