Position Details

Department: Physician Revenue Cycle
Category: Patient Financial Services
Location: Phoenix
Posting #: 486083
Date Posted: 11/19/2019
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. Reviews and analyzes accounts, reports, and EOBs to identify, track, and appeal over and under-allowed claims.
  2. Batches, compiles, and submits appeals and monitors payments for proper reimbursement. Documents all variance and appeal activity in the appropriate system.
  3. Maintains reports to aid in work flow and appeal opportunities and to track recovery payments.
  4. Establishes and maintains effective communication with payers and leadership to secure accurate and pertinent information to maximize reimbursement.
  5. 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.
  6. Verifies applicable contract rates by reviewing payer contracts, EOBs, and verifying member information for all healthcare plans.
  7. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
1. Associates degree or higher in Healthcare, Business, or closely related field, or equivalent combination of post-secondary education and experience. Preferred
2. Bachelor`s degree or equivalent combination of post-secondary education and experience. Preferred
Do you meet this requirement?
1. Two years experience account follow-up, zero payment denials, denial resolution, and underpayment/variance resolution in a healthcare setting. Required
Do you meet this requirement?
1. Credentialed Revenue Cycle Representative Preferred
2. Certified Patient Account Representative Preferred
3. Certified Patient Account Technician Preferred
Do you meet this requirement?
Special Skills
1. Knowledge of managed care contracts, AHCCCS, third party payers and multiple types of reimbursement. Required
2. Ability to identify, analyze, solve problems, and recognize patterns in data Required
3. Ability to organize and manage detailed processes Required
4. Knowledge of trending reports related to denials and payment variance Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Frequently
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Frequently
4. Physical Requirement - Hearing Frequently
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Frequently
10. Physical Requirement - Talking Frequently
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Frequently
13. Physical Requirement - Near Vision Frequently
14. Physical Requirement - Far Vision Constantly
15. Physical Requirement - Color Discrimination Occasionally
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Frequently
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
20. Occupational Exposure/Risk Potential - Confined areas Applicable
21. Occupational Exposure/Risk Potential - Fumes or airborne particles Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply