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
- Start : 08/26/2018
- Terms: 13 WEEKS
- Shift: 8 hours - Days - M-F 8:30AM - 4:30PM
- 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.
- 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.
- 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.
- Bachelor's Degree (Preferred)
- H.S. Diploma, GED, or Equivalent (Minimum)
- 2 Years of Experience (Minimum)
- 4 Years of Experience (Preferred)
Licenses & Certifications:
- Cert Patient Account Manager (Preferred)
- Cert Patient Account Tech (Preferred)