This position is responsible for conducting regular analysis of payments received from contracted payers, making quantitative comparisons to determine if the appropriate reimbursement was received, monitoring contractual allowances, and analyzing and pursuing appeal opportunities with contracted payers and reporting variance/appeals performance.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- Reviews and analyzes accounts, reports, and EOBs to identify, track, and appeal over and under-allowed claims.
- Batches, compiles, and submits appeals and monitors payments for proper reimbursement. Documents all variance and appeal activity in the appropriate system.
- Maintains reports to aid in work flow and appeal opportunities and to track recovery payments.
- Establishes and maintains effective communication with payers and leadership to secure accurate and pertinent information to maximize reimbursement.
- Uses good interpersonal skills to promote positive and effective interaction with others. Promote quality service to ensure the flow of information to appropriate staff, provider representatives and leadership.
- Verifies applicable contract rates by reviewing payer contracts, EOBs, and verifying member information for all healthcare plans.
- Performs miscellaneous job related duties as requested.