Payment Variance Representatives -Two Openings
Option 1 Staffing is an award winning, statewide, recognized leader in staffing and recruiting, specializing in placing the highest caliber of Non-Clinical Healthcare, Information Technology, Supply Chain, Administrative/Office and Accounting/Finance professionals in contract and direct-hire opportunities. We work with top and emerging companies in the Technology and Healthcare industry.
The Payment Variance Representatives performs managed care insurance payment audit/underpayment identification, research, analysis, reporting, and collections functions. Ensures claims are paid appropriately pursuant to negotiated payment rates with managed care insurance payers. Reports all significant underpayment issues, trends, and systemic issues to Revenue Cycle Senior Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. Keeps informed of managed care and contractual arrangements in order to resolve and process accounts by managed care insurance payers. Follows up on all payment variances for account resolution through insurance payer’s online tools, phone calls, and periodic in-person meetings with insurance payer liaisons. Collaborates closely with the Contracting Services Department to facilitate escalation of significant and systemic insurance payment issues. Ensure all accounts are resolved in a compliant manner and according to all applicable hospital policies/procedures, rules, and regulations. After multiple unsuccessful appeal attempts, the Payment Variance Representative is tasked with carefully evaluating all factors and exercising prudent decision making to determine whether to continue or cease pursuit of insurance payment, subject to specific dollar threshold(s) outlined in hospital policies and procedures.
High School Diploma or equivalent
Minimum of five (5) years related work experience in a Hospital Billing setting
Minimum of three (3) years related work experience involving interpretation/analysis of managed care contract payment terms
Strong critical thinking and analytical skills
Strong verbal and written communication skills
Proficient in HMO, PPO, Managed Medicare, Managed Medi-Cal, and 3rd party rules and regulations
Proficient in managed care contracting payment terms and rate structures for hospitals
Works in a collaborative and team manner
Basic to intermediate skill level in Microsoft Excel (Microsoft Access is a plus)
For immediate consideration, please apply!
“Best of Staffing Award”
Best of Staffing Award is the only award in the U.S that recognizes staffing agencies that have proven superior service quality based entirely on ratings provided by their clients and job candidates. Award winners make up less than 2% of all staffing agencies in North America.
“Top Performer Award”
Top Performer Award by Workforce Logiq highlights high-performing staffing companies who are chosen based on a variety of criteria critical to our clients’ satisfaction, including customers serviced, cycle time, submittals per requisition, percentage of submittals hired, program compliance, fill ratio, and more.
Member American Staffing Association Since 1991.