Reimbursement Integrity Specialist (Remote) presso Napaanesthesia
Napaanesthesia · Sunrise, Stati Uniti d'America · Remote
- Professional
Position Requirements
The Reimbursement Integrity Specialist is responsible for identifying, investigating, and resolving payment discrepancies based on payor contracts across multiple divisions. This role involves conducting detailed analyses to detect underpayments, overpayments, and other variances, ensuring adherence to payer contract terms. The specialist will independently research the root causes of variances, including registration errors, system issues, incorrect rate applications, and policy changes, and take corrective action to ensure accurate payment reconciliation.
RESPONSIBILITIES
Payment Variance Identification & Investigation
- Reconcile payments from payors, identifying and analyzing discrepancies such as underpayments, overpayments, and other variances based on payer contracts.
- Investigate the root causes of payment variances, including incorrect registration data, policy changes, billing errors, or system misconfigurations.
- Document findings from variance investigations, detailing the nature of discrepancies, their financial impact, and any corrective actions taken.
Root Cause Analysis & Issue Resolution
- Analyze payment discrepancies by comparing contracted rates with actual payments received.
- Identify patterns and systemic issues contributing to recurring variances.
- Apply corrective actions based on analysis to resolve identified payment issues.
Reporting & Performance Monitoring
- Maintain detailed records of payment reconciliation outcomes and variance trends.
- Monitor and track key performance metrics related to payment accuracy and reconciliation efficiency.
- Generate routine reports summarizing discrepancies, resolutions, and overall reconciliation performance.
Process Improvement & Workflow Optimization
- Identify inefficiencies in the reconciliation process and propose individual-level improvements to enhance accuracy and timeliness.
- Implement workflow adjustments independently to reduce the occurrence of future discrepancies.
- Continuously evaluate and refine personal work methods to support operational efficiency.
REQUIRED QUALIFICATIONS
- Minimum of 2-3 years of experience in healthcare revenue cycle management, with a focus on payment reconciliation or payor variance resolution.
- Familiarity with healthcare reimbursement methodologies (e.g., fee-for-service, capitation, value-based care) and payer contract structures.
- Experience using revenue cycle management software and financial systems for payment reconciliation tasks.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and other relevant software for tracking and reporting payment discrepancies.
- Excellent verbal and written communication skills for interacting with internal teams, payors, and external stakeholders.
- Ability to manage multiple priorities and work in a fast-paced environment while adhering to deadlines.
PREFERRED QUALIFICATIONS
- Knowledge of healthcare regulations, payer contract compliance, and industry best practices.
- Ability to maintain confidentiality and handle sensitive information in a professional manner.
TOTAL REWARDS
- Generous benefits package, including:
- Paid Time Off
- Health, life, vision, dental, disability, and AD&D insurance
- Flexible Spending Accounts/Health Savings Accounts
- 401(k)
- Leadership and professional development opportunities
EEO Statement
North American Partners in Anesthesia is an equal opportunity employer.
Candidarsi ora
