Contract Variance Analyst Senior

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. 

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. 

This position is remote. May requires travel. 

Operates all equipment necessary to perform the job.