Senior Contract Variance Analyst

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🔥 13 hours ago

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Advocate Aurora Health

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 $10.2M Grant on 2019-08

Healthcare Insurance

Advocate Aurora Health is a leading healthcare organization that operates across various regions including Central Chicagoland, Central Wisconsin, Greater Milwaukee, and more. With a diverse range of career areas such as advanced practice clinicians, behavioral health, nursing, and more, Advocate Aurora Health is committed to helping people live well. The organization offers numerous benefits and opportunities for career advancement, fostering an environment where individuals can thrive and innovate in the healthcare sector. Advocate Aurora Health prioritizes the safety of its candidates and maintains a robust recruitment process to protect sensitive information.

📋 Description

• 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 • 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 • 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 • Monitor and report progress and resolution of trends, evaluating their financial impact on the Revenue Cycle • Report new trends to management during weekly meetings • 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 • Communicate and escalate problematic variances, delays, and significant reimbursement issues to management, Managed Health, payers, and other stakeholders • Compile and submit escalation reports for Payer/Department meetings

🎯 Requirements

• Bachelor's Degree in Accounting, Health Care Administration or Equivalent Experience • 6 years of Revenue Cycle or Managed Health experience related to payment resolution at a large hospital or integrated healthcare delivery system • 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.

🏖️ Benefits

• 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 • Paid Time Off programs • 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