Payment Variance Specialist
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
This position is responsible for Steward Medical Group follow up operations, meeting goals and company objectives, in assigned areas of patient/insurance credit balances,underpayments, collections, payment validation, customer service and correspondence using the Athena web system. Associate must ensure that all process meet all government mandated procedures for integrity and compliance. Performs all responsibilities in a prompt and efficient manner. Must be detail oriented meeting multiple deadlines while working independently and/or in small groups. Revenue Cycle Payment Variance Specialist knowledge is required and Athena experience is preferred. The Payment Variance Specialist reports to the Payer Intelligence Supervisor or Manager.
• Process refunds for patient and insurance for all markets in Athena
• Analyze patient account to determine true credit balances
• Initiate patient refunds via Athena interface
• Initiate AR followup team payer refunds and Vendor patient/insurance refunds manually via RDU file creation
• Verify AR payer refund backup
• Upload RDU files to Cognizant via Catalyst
• Cognizant reporting in Catalyst to balance with Refund A
• Work Exceptions in Catalyst
• Create refund Payment Proposals
• Submit signed Payment Proposals to Treasury
• Enter patient refund check numbers into Athena
• Returned checks – Bad Address research addresses Meditech/Athena and update in system
• Mail Vendor payer refund checks to the vendor for mailing to payers with backup
• Mail Athena payer refund checks with all corresponding backup to appropriate address
• Follow the Abandoned Property process
• Run reports weekly related to refunds
• Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations
• Other duties as assigned
Required Knowledge & Skills:
• High school diploma or equivalent required. Associates degree preferred.
• 2-3 years experience with medical billing/collection; physician billing experience preferred.
• 2-3 years experience with Revenue Cycle Payment Variances including patient/insurance credit balances, underpayments, initiation of refunds, reconciliation and EOB interpretation
• Knowledge of basic medical coding/terminology and third-party insurance operating procedures and practices a plus
• Experience with patient accounting, contract management systems and billing/claim submission software; specific Athena Health experience a plus
• Knowledge of revenue cycle and/or business office procedures.
• Ability to utilize basic Microsoft Office programs
• Moderate to advance level of excel knowledge-including pivot tables
• Highly detail oriented and well organized
• Ability to read, understand and follow oral and written instructions
• Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Steward
Job Status: Full Time
Job Reference #: 43145