This position serves as a Physician Billing Financial Services Representative 2 in the Reimbursement Variance Department.
The main objective is the identification and resolution of insurance account variances on paid physician claims. All payor related reimbursement variances will be analyzed to determine if insurance payment was within managed care payor specific contract terms. The candidate will have the ability to demonstrate resourcefulness while performing day to day job duties along with being able to adapt to changing situations. The candidate will exemplify the Mission, Vision and Values and acts in accordance with policies and procedures.
Address all physician billing payment variance types assigned (overpayments and underpayments)
Responsible for researching and reconciling insurance company requests for payment refunds. Research includes, but not limited to, reviewing payor contracts, payor billing reimbursement policies, and guidelines
Determine root causes for insurance payment discrepancies while partnering with internal and external resources with recommendations for resolution to minimize inappropriate variances in payment. Identify insurance coverages inaccuracies and take steps to correct it when necessary
Maintain knowledge of current, new, and terminated payor contracts while communicating such updates to peers and management
Prioritize proper and detailed documentation in Epic related to all actions taken on patient accounts
Ensure the protection of patient private health and personal information, including financial and non-financial information
Participate in ad hoc projects and other duties as assigned by management
Collaborate with other revenue cycle departments and physician offices when needed
Adhere to all federal and state compliance regulations
Experience of physician billing and collections preferred
Experience in researching and reconciling insurance company refund requests
Knowledge of EPIC PB applications required
Understanding of how to clearly identify physician payments as: underpaid, overpaid, denied, or paid per contract terms
Proficient in MS Office Excel and Word
Analytical skills essential for calculating contractual reimbursement and determining if the physician has been paid per contract terms
Demonstrates resourcefulness while performing day to day job duties along with being able to adapt to changing situations with ease and speed
Ability to work as part of a team to collectively reach team goals
Ability to analyze explanation of benefits for commercial and government payors
Must be able to work independently with a high degree of accuracy
Strong interpersonal skills are required for communication of finance-related issues to management and ancillary departments
Participation in training sessions to maintain awareness and knowledge of evolving heath care policy changes
Rush University is ranked 22nd on the Times Higher Education's 2016 list of the world's top 150 universities under 50 years of age.
Rush University is a health science university that is integral to Rush, an academic health system that includes three hospitals and numerous outpatient care facilities.
Rush University's Nursing Administration program is ranked in the top four in the nation by U.S. News & World Report.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.