• Employment Type: Full Time
• Shift: Days
• Location: Boston, MA

Job Summary:

The Payment Variance Analyst, under the supervision of Manager of Payment Integrity, performs extensive analysis and various follow-up activities to ensure the integrity of billing and reimbursement of medical services provided by the hospital are accurate and appropriate. Responsibilities include identifying payment variances and working internally and externally to resolve such issues in order to recover underpayments.

Essential Responsibilities:

• Identify and analyze payment variances, working closely with third party payers to resolve issues and ensure correct reimbursement. Present recommendations to Manager regarding billing, charge, and coding issues
• Work with other hospital departments, including, but not limited to, Patient Accounts, Health Information Management, Continuity of Care, and clinical areas to ensure revenue integrity.
• Identify and bring contract rate discrepancies as well as missing payment or claim files to the attention of the supervisor and/or manager.
• Analyze and gather supporting documentation to process appeals to third parties, and follow up with payers accordingly
• Perform research and analysis related to billing and reimbursement. Maintain current knowledge in the areas of third party billing, reimbursement schedules and methodologies, coding, payer contracts, billing and payment rules and regulations, and hospital billing compliance.
• Research and assess third party denials in the contract management system, reporting trends to the Manager.
• Evaluate and take appropriate action on third party audit results and/or retractions, including validating audit findings and reimbursement, summarizing the results of the review, and proposing and assisting with next steps if applicable.
• Produce ad-hoc reports for leadership team.
• Perform special projects and other duties, as assigned.

Proficiencies

• Ability to work independently and use critical thinking.
• Detailed knowledge of reimbursement schemes for predominant payers.
• Detailed knowledge of regulatory requirements, particularly Medicare and Medicaid.
• Detailed knowledge of CPT, HCPCS, revenue codes and ICD-10 CM.
• Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Abilities

Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical thinking and the ability to meet deadlines.

Education

Bachelors degree from a recognized college or university in business, healthcare or a closely related field. At least 3 years-experience in Patient Accounts or related accounting field, Managed Care, Reimbursement or Third party Payer work.

An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

Knowledge/Skills

• Experience in EPIC installations preferred
• Knowledge of third-party requirements, state and federal regulations.
• Knowledge of payer enrollment processes.
• Knowledge of government and commercial payer requirements for accurate and compliant charging and billing of hospital inpatient, outpatient, surgical and ancillary services.
• Knowledge of CPT, HCPCs, and revenue codes.
• Experience with Microsoft Office (Outlook, Word, Excel, Power point, Access).
• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)
• Knowledge of regulatory publications, how to access and interpret.
• Knowledge of medical terminology.
• Strong analytical and problem-solving skills
• Ability to work independently, prioritizing and organizing their work.
• Strong verbal and written communication skills.
• Ability to project manage small to medium projects

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.