Reimbursement Variance Analyst in Westerville, Ohio at Orthopedic One

Updates existing fee schedules with payer allowed amounts annually (or as necessary)

Attaches new schedules to all providers, expiring old schedule

Monitors CMS & commercial payer websites and transmittals for regulatory changes in reimbursement policies

Revises Standard Fees to comply with federal & state billing regulations & guidelines

Runs carrier variance reports and researches payment inconsistencies identified

Corrects invalid allowed amounts in corresponding fee schedules

Appeals underpayment errors with carriers

Identifies & reports carrier trends to Director

Validates insurance overpayments in demand letters from carriers and refund requests from A/R reps, making appropriate account adjustments as needed

Runs monthly credit balance reports to identify patient overpayments, conveys funds when appropriate, and places account in refund status

Forwards refund requests to Finance Department staff with supporting documentation

Processes patient and insurance refund checks for mailing with appropriate claim reconsideration forms or explanation letter, verifying payee name and address

Analyzes overpayment trends and recommend corrective procedures

Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.

Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.

Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance

Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.

Works cooperatively and refrains from participating in negative conversations.

Shares knowledge and insights with co-workers in a constructive manner.

Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.

Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.

Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.

Provides assistance and support to leadership in implementing policies and procedures as necessary.

Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

High School Diploma or equivalent required. Previous medical billing experience, preferably in an orthopedic surgery specialty is required. Candidates must have current certification as a Certified Professional Coder. Proficiency with software including practice management systems and Microsoft Excel