Underpayment Management Specialist

  •  

San Diego, CA

Industry: Healthcare

  •  

Not Specified years

Posted 99 days ago

  by    Samir Singh

This job is no longer available.

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)