Remote Variance Analysis Jobs (NOW HIRING)

Department:
10291 Enterprise Revenue Cycle - HB and PB Payment Variance
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:

• Full time, Day shift, Monday - Friday
• Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.
• Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).
• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

Pay Range
$30.70 - $46.05
Major Responsibilities:
Underpayments Management: Oversee the Hospital (HB) and Professional (PB) Underpayments Management process. Serve as the liaison to management and for payer meetings/escalation to address contractual variance issues. Optimize net 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 on contract payment discrepancies escalated by Variance Specialists. Conduct quality reviews and monitor teammate productivity. Recommend and update variance process flow documentation, policies, and procedures. Provide training and serve as a super user for the department. Adhere to Revenue Cycle guidelines for Adjustment Authorization approvals.
Appeals Processing: Ensure timely processing of appeals in accordance with payer/contract guidelines and Revenue Cycle policies. Escalate appeals in process when necessary. Advise on 2nd 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 and contract variance trends. Develop and implement corrective action plans to resolve payment discrepancies. Maintain reports identifying accounts 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 their financial impact on the Revenue Cycle. Report new trends to 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 enhance the patient experience. Identify and escalate operational issues to improve organizational performance. Collaborate with Revenue Cycle Departments, Managed Health, Finance, and the Contract Build team to develop and implement corrective action plans to minimize preventable payment variances. Ensure contractual allowances are accurate. Work with management to implement changes to address internal process flow deficiencies.
Communication and Escalation: Communicate and escalate problematic variances, delays, and significant reimbursement issues to management, Managed Health, payers, and other stakeholders. Report changes in payer requirements that significantly affect reimbursement and/or aging. Escalate underpayment issues to payer provider representatives and aggressively seek resolution. Compile and submit escalation reports for Payer/Department meetings. Inform management of significant payer/contract issues with material financial impact on Revenue Cycle Operations. Refer insurance and patient refunds to the Refund Team.
Special Projects: Complete special projects assigned by management accurately and timely. Gather, compile, and interpret data, department reports, and logs as requested. Prepare and implement strategic action plans and process improvement initiatives. Monitor and audit the execution of strategic initiatives, process redesign, metric/report development, and special projects for the Department. Collaborate closely with management to continually improve processes and positively impact the Revenue Cycle.
Policy Adherence: Adhere to Advocate Health, Revenue Cycle, and departmental policies and procedures. Be accountable and model organizational behaviors of excellence.
Licensure, Registration, and/or Certification Required:
None Required.
Education Required:
Bachelor's Degree in Accounting, Health Care Administration or Equivalent Experience
Experience Required:
6 years of Revenue Cycle or Managed Health experience related to payment resolution at a large hospital or integrated healthcare delivery system.
Knowledge, Skills & Abilities Required:
Excellent management and leadership skills.
Excellent communication, organizational and customer service skills.
Excellent and thorough knowledge of all aspects of the hospital revenue cycle as well as the supporting systems, reimbursement and governmental regulations and reimbursement models in effect.
Demonstrate high performance of leadership skills including ability to work well with others, team building, organizational, communication and presentation skills.
Ability to work collaboratively across disciplines.
Excellent process redesign skills.
Highly customer focused.
Ability to interpret and understand a Managed Care Contract.
Knowledge of medical terminology, UB-04 requirements and CPT, HCPCs Coding.
Strong knowledge of PCI compliance and how it pertains to the Health Care environment.
Demonstrate ability to react quickly to an ever-changing environment.
Physical Requirements and Working Conditions:
This position is remote. May requires travel.
Operates all equipment necessary to perform the job.
DISCLAIMER
All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.