This position offers you the opportunity to work from home (WFH) after all training has been completed. Once completed you will need to be available to come into the office for additional training, meetings etc., as needed.

The Patient Financial Services Payment Review position is responsible for debit and credit payment variance reviews. The Payment Specialist works independently and is responsible for the review of complex managed care contracts and reimbursement methodologies, ensuring accurate overpayment and underpayments are documented. Applies independent judgment and knowledge to audit third-party payer payment disputes. Documents and/or notifies management of preventive measures in response to payment trends identified through analysis of claims data. Works with management staff identifying corrective measures necessary to resolve problems. Understands and utilizes many complex and varying California and Federal Statutes and regulations, guidelines and systems to ensure appropriate billing and collections are in compliance. The Payment Specialist will manage resources responsibly. The position is essential to Patient Financial Services accurately capturing and recovering hospital revenue timely and efficiently.

Essential Functions and Responsibilities of the Job

• Ability to research and use critical thinking skills in contract interpretation of third-party payers to determine the appropriate maximum reimbursement.
• Ability to apply knowledge of state and federal regulations regarding correct payment practices.
• Ability to utilize appropriate resources, both hard-copy and online, to facilitate correct payment.
• Ability to research and follow-up on insurance and patient refunds to ensure accurate account balances.
• Ability to document precise notes in the financial system of all transactions and correspondence.
• Able to be at work and on time, follow organization rules and procedures and directions from a Coordinator/Lead or other member of the Management staff.
• Able to adhere to all confidentiality policies and procedures and carries out all tasks in a pleasant and respectful manner.
• Ability to make suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures and practices.
• Ability to use critical thinking while reviewing billing and collection notes in the financial computer system to ensure that the appropriate action is taken within the billing and collection process to ensure correct hospital reimbursement.
• Follow company policies, procedures and directives
• Interact in a positive and constructive manner
• Prioritize and multitask

Experience

• Candidate with a minimum of 3 years’ experience in Hospital Revenue Cycle including HMO, PPO, Medicare Advantage and Managed- Medi-Cal collections and payment review
• Understanding of managed care hospital contracts including exclusions, lesser of and not to exceed, etc. and knowledge of hospital Commercial billing or collection processes
• Current experience with Medicare IPPS and OPPS payment methodologies
• EPIC experience required.
• Microsoft Office (Excel, Outlook & Word)
• Basic knowledge of medical terminology and familiar with CPT and ICD coding
• Use of 10-key calculator by touch
• Excellent written and verbal communication skills
• Understand and follow oral and written instructions
• Interact tactfully and courteously with the public and peers
• Proficient organizational and prioritization skills
• Adhere and apply specific departmental policies, rules and regulations