Underpayment Management Specialist

  •  

San Diego, CA

Industry: Healthcare

  •  

Not Specified years

Posted 43 days ago

  by    Samir Singh

We are looking for Underpayment Management Specialist for our client in San Diego, CA

Job Title: Underpayment Management Specialist

Job Location: San Diego, CA

Job Type: Contract - 12 Months / Contract to Hire / Direct Hire

Job Description:

  • Start : 08/26/2018
  • Terms: 13 WEEKS 
  • Shift: 8 hours - Days - M-F 8:30AM - 4:30PM

Description:

  • The manager is looking for an Underpayment Management Specialist who is able to work M-F 8:30 a.m. - 4:30 p.m. for a duration of 13 weeks with the possible extension. 

Job Responsibilities:

  • Underpayment Management Specialist Audits bills for account payment, accurate Managed Care Contracts & government fee schedules, re-billing & follow-up on open inventory. 
  • Conduct Managed Care payment reviews - audits of HMO, PPO, Managed Medicare/Medicaid, workers- compensation & TRICARE accounts to ensure RCHSD receives full reimbursement from health plans & insurance/workers- compensation carriers. 
  • Review Managed Care account activity from Epic, Chartmaxx, & Ancillary Systems. Work with Managed Care Department, payer contracts, & claims processing units to identify root cause & present issues to the appropriate level for resolution. 
  • Review zero balance patient accounts (receivables) in conjunction with a detailed contract analysis to ensure payments received are in accordance with the terms of the managed care contract or fee schedule. 
  • When the terms of the contract are not properly executed, identify, analyze & recoup underpaid amounts. 
  • Facilitate status meetings with the PFS staff to discuss the underpayment findings & make recommendations in order to maximize reimbursements.
  • Facilitate status meetings with Contracting staff to help clarify language interpretations & negotiate practical compliance terms. 
  • Create all necessary reports & presentations based on department & organizational goals. 
  • Monitor underpayments; perform global audits on payment variances & payer issues/contract issues.

Requirements:

  • Must possess proven ability to track & trend payer-specific issues & report findings to the Managed Care department to support modifications in payer negotiations.
  • Supply monthly reporting by type, dollar amount, & resolution. 

School Education:

  • Bachelor's Degree (Preferred)
  • H.S. Diploma, GED, or Equivalent (Minimum)

Experience:

  • 2 Years of Experience (Minimum)
  • 4 Years of Experience (Preferred)

Licenses & Certifications:

  • Cert Patient Account Manager (Preferred)
  • Cert Patient Account Tech (Preferred)