Payment Variance Follow Up Representative

Job Purpose

The Payment Variance Follow Up Representative is responsible for collecting outstanding insurance reimbursement due to contractual discrepancies.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.  
• Perform payment variance analysis to identify trends in underpaid claims
• Identify and report underpayments and denial trends
• Initiate appeals when necessary
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients
• Maintain confidentiality at all times
• Maintain a professional attitude
• Other duties as assigned 
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Understand and comply with Information Security and HIPAA policies and procedures at all times 
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• High School Diploma or equivalent required 
• 3 years’ experience in Commercial insurance collections, including submitting and following up on claims
• Experience in Hospital/Facility billing
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Detailed knowledge of Managed Care reimbursement methodologies
• Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04
• Ability to analyze, identify and resolve issues causing payer payment delays 
• Proficiency with MS Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization 
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses 
• High level of integrity and dependability with a strong sense of urgency and results oriented  
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction 

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. 
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. 
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.