This position is responsible for conducting regular analysis of payments received from contracted payers, making quantitative comparisons to determine if the hospital received the appropriate reimbursement, monitoring contractual allowances, analyzing and pursuing appeal opportunities with contracted payers and reporting variance/appeals performance.

• Reviews and analyzes accounts and EOBs to identify under-allowed claims.
  
• Batches, compiles, and submits appeals and monitors payments for proper reimbursement. Documents all variance and appeal activity in the hospital system.
  
• Creates reports to aid in workflow and appeal opportunities and track recovery payments.
  
• Establishes and maintains effective communication with employers, other healthcare providers, insurers, and patient/families to secure accurate and pertinent information to maximize reimbursement.
  
• Monitors and tracks contractual, billing, registration, and posting errors and provides continuous feedback to the department supervisor regarding any consistently under-allowed claims.
  
• Uses good interpersonal skills to promote positive, effective interaction with customers and to promote quality service to ensure flow of information to appropriate staff and professionals.
  
• Verifies applicable contract rates by reviewing EOB messages, patient ID card, and verifying member information for managed care plans.
  
• Performs miscellaneous job related duties as requested.
  

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

Values

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable