The Payment Audit Specialist (PAS) reports to the system director of Finance and is responsible for reviewing Payer Contract variances as generated by the System’s Contract Modeling software, or otherwise identified for further investigation. The PAS is also responsible for following up with the affected payers (in conjunction with colleagues in Reimbursement, System Revenue Cycle and Payer Contracting) in order to achieve successful resolution of outstanding variances. The PAS will also provide as requested periodic updates regarding Variance Conversion percentage and dollars re-harvested from the System’s Contract Underpayment efforts.

Essential Function

• Complete Contract Underpayment work lists as assigned, focusing initially on high dollar return and low hanging fruit variances. Contact appropriate payer representatives to provide evidence of alleged underpayments, and follow to resolution.
• Updates status of assigned accounts in Claim Tracking software, including copious notes regarding payer response (or lack thereof). Brings issues and bottlenecks in underpayment recovery process to System Director for escalation as needed.
• Works with Reimbursement Team (and others as mentioned above) to fine tune contract rules in the Modeling software, to eliminate unnecessary variance amounts.
• Works with Revenue Cycle Team regarding issues identified as posting errors, incorrect payer coding, and other transactional issues.
• Assists the Reimbursement Team as requested in items related to reimbursement, revenue cycle, coding and similar/related issues.
• Generate/run variance reports as needed, or as requested by Director.

Education (experience can be substituted for education)

High School Diploma Required

Associates Degree Preferred

Work Experience (education can be substituted for experience)                               

1-3 years of health care finance experience required.

Knowledge, Skills and Abilities

• Knowledge of the revenue cycle process
• Knowledge of Medicare and Medicaid regulations
• Attention to detail and ability to push through obstacles
• Ability to probe/investigate and find discrepancies, errors, omissions and bring to resolution
• Excellent critical thinking skills.
• Good spreadsheet and other computer skills
• Ability to communicate with third-party payers/auditors
• Ability to work independently in a time-oriented environment.
• Excellent skills in managing workload timely and efficiently
• Works well within a team environment, even when team is geographically distributed