Analyst, Payment Variance (Hybrid)

About the position 1. Troubleshoot and evaluate work product of staff, make recommendations to management and implement changes. 2. Participate with management in strategizing for Process Improvement initiatives. 3. Attend and participate in management meetings. 4. Work with management on special organizational projects for CCH. 5. Participate in and provide input and feedback for employee evaluations. 6. Works with managed care contracting, Patient financial services, software vendors, third party payer payers to identify root cause of payment variances and address and make appropriate changes to resolve payment variances. 7. Resolves payment variance issues and ensures that the hospital is reimbursed correctly according to the contract terms. 8. Monitors and audit payment variance software to ensure contracts are properly loaded and payment calculations are correct. 9. Review payment variance reports for accuracy. 10. Analyze payment transactions and identify trends using Payment Variance Software, Websites and other online communications. Identify missing charges and work with Clinical Departments, Physician Clinics and Practices to develop new charges. 11. Collaborate with department managers and staff to review documentation supporting charge capture, identify areas of deficiency and develop process improvement programs to support compliant billing 12. Assist the Senior Clinical Manager in developing ongoing educational programs on charge capture and reconciliation for department managers and their staff 13. Develops and deliver organized, concise yet thorough communications to management, Sr. Leadership, and other departments regarding proposed, deficiencies, developments and opportunities affecting the Organization with regard to charge capture and payment variances. 14. At the request of clinical department managers, attend staff meetings to present identified problems and solutions related to payment variance, reconciliation and documentation. 15. Working with department managers, develop and revise tools for documenting departments’ processes for charge capture and reconciliation to prevent payment variances. Assure that all tools are reviewed and revised periodically. Monitor CCH intranet website to assure posted documents reflect current processes. 16. Using knowledge of CDM, coding and billing, collaborate with MIS, Revenue Cycle Team and Medical Records (HIM) managers, supervisors and staff to identify and document best practices for CCH charge capture. 17. Maintain professional affiliations and attend seminars, conferences, etc. 18. Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines. 19. Performs other job related duties and assignments as requested. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital’s commitment to CARES: compassion, accountability, respect, excellence and service.

Responsibilities

• Troubleshoot and evaluate work product of staff, make recommendations to management and implement changes.
• Participate with management in strategizing for Process Improvement initiatives.
• Attend and participate in management meetings.
• Work with management on special organizational projects for CCH.
• Participate in and provide input and feedback for employee evaluations.
• Works with managed care contracting, Patient financial services, software vendors, third party payer payers to identify root cause of payment variances and address and make appropriate changes to resolve payment variances.
• Resolves payment variance issues and ensures that the hospital is reimbursed correctly according to the contract terms.
• Monitors and audit payment variance software to ensure contracts are properly loaded and payment calculations are correct.
• Review payment variance reports for accuracy.
• Analyze payment transactions and identify trends using Payment Variance Software, Websites and other online communications. Identify missing charges and work with Clinical Departments, Physician Clinics and Practices to develop new charges.
• Collaborate with department managers and staff to review documentation supporting charge capture, identify areas of deficiency and develop process improvement programs to support compliant billing
• Assist the Senior Clinical Manager in developing ongoing educational programs on charge capture and reconciliation for department managers and their staff
• Develops and deliver organized, concise yet thorough communications to management, Sr. Leadership, and other departments regarding proposed, deficiencies, developments and opportunities affecting the Organization with regard to charge capture and payment variances.
• At the request of clinical department managers, attend staff meetings to present identified problems and solutions related to payment variance, reconciliation and documentation.
• Working with department managers, develop and revise tools for documenting departments’ processes for charge capture and reconciliation to prevent payment variances. Assure that all tools are reviewed and revised periodically. Monitor CCH intranet website to assure posted documents reflect current processes.
• Using knowledge of CDM, coding and billing, collaborate with MIS, Revenue Cycle Team and Medical Records (HIM) managers, supervisors and staff to identify and document best practices for CCH charge capture.
• Maintain professional affiliations and attend seminars, conferences, etc.
• Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.
• Performs other job related duties and assignments as requested. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital’s commitment to CARES: compassion, accountability, respect, excellence and service.

Requirements

• Bachelors of Science preferred.
• Minimum of one to two years experience in financial management in an acute care hospital
• Experience with large hospital information systems required, preferably with Siemens Sorian.
• Knowledge and expertise in the following areas: hospital and physician billing requirements, CPT/HCPCS coding schemes and hospital and physician reimbursement methodologies.
• Excellent interpersonal, problem solving, critical thinking and written skills.
• Demonstrated ability to work effectively with department heads and supervisory staff.
• Ability to work with minimum of supervision.

Nice-to-haves

• Superior Excel Skills using Pivot Tables and other Advanced Functions, proficient use of Microsoft Project, PowerPoint and Visio desired.

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