Payment Variance Analyst (Full-Time)

OrthoNebraska creates the inspired healthcare experience all people deserve by giving people a direct path to personalized care and life-enhancing outcomes. With a focus on safety and people, we set the bar high in providing high-quality care with an unmatched experience. Our team members are critical to our success and growth and are rewarded for their dedication and hard work. IF this sounds like the type of team and environment you want to be a part of apply today!

Position Summary: The Payment Variance Analyst is responsible for identifying, analyzing, and resolving discrepancies between expected and actual payments from insurance companies by auditing medical claims, analyzing payer contracts, and submitting appeals to recover the correct reimbursement amount.

Position details

Position Requirements

Education: High School Diploma or General Educational Development (GED) required.

Licensure: N/A

Certification: N/A

Experience: 2+ years of healthcare experience and billing experience required; Healthcare contract experience preferred.

Required Knowledge/Skills/Abilities

• Strong communication, including writing, speaking and active listening.
• Great customer service skills, including interpersonal conversation, patience, and empathy.
• Good problem-solving and critical thinking skills.
• In-depth knowledge of industry best practices.
• Strong understanding of reimbursement methodologies.
• Must be able to multi-task with multiple interruptions in a fast-paced environment.

Essential Job Functions

• The Payment Variance Analyst will examine medical claims to verify proper reimbursement and work with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies.

• Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amount from insurance carriers.
• Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
• Contact insurance companies to obtain missing information, explain and resolve payment variances and arrange for payment or adjustment processing.
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, reconsiderations, and appeals.
• Maintain thorough documentation, including root cause of variance issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
• Can navigate and interpret various payer policies and contracts.
• Proactively identifies, researches and resolves unusual, complex or escalated issues, as necessary. Escalates ongoing issues or concerns with leadership.
• Meets quality assurance and productivity standards through identification and reconciliation of variances in accordance with organizational policies and procedures.
• Serves as a dedicated subject matter expert to answer questions pertaining to contract variances.

• Actively participate in achieving team goals, setting priorities, seizing opportunities before being asked, and motivating oneself and others to maximize productivity

• Adapts quickly to frequent process changes and improvements.
• Maintain up-to-date knowledge of all business office policies and procedures, team goals, department objectives and hospital strategic plans to maximize the decision-making process.

• Demonstrate communication and problem-solving skills by clearly presenting information and options to customers while removing barriers that fail to enhance customer service
• Maintain confidentiality to protect patient rights and privacy.
• Comply with safety activities, policies and procedures and regulatory requirements such as OSHA and The Joint Commission
• Employee is responsible for all other duties as assigned for which competency has been demonstrated.

Physical requirements: This position is classified as Sedentary Work in the Dictionary of Occupational Titles, requiring the exertion of up to 10 pounds of force occasionally) up to (33% of the time) and/or a negligible amount of force frequently (33%-66% of the time) to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.

Must be able to pass background check. We also conduct pre-employment physical and drug testing. Any job offer will be contingent upon successful completion of a pre-employment physical with a drug screen, background check and obtaining active licensures per job requirements.