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Exemption Status:

Non-Exempt

Hiring Range:

$20.94 - $33.59

Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Monday through Friday

Scheduled Hours:

8:30a - 5:00p Flexible

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5416 Payment Variance and Contracts

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsible for processing payment discrepancies (under/overpayments). Reviews, analyzes and initiates appropriate action for discrepancy resolution.

I. Major Responsibilities:

1.  Prioritizes standards and guidelines to perform payment variance follow up utilizing assigned work queue.
2.  Analyzes and researches overpayments and underpayments with payers. Determines and executes the best approach for resolution. 
3.  Validates payment discrepancies using Hospital Billing Revenue Cycle management system calculations. Identifies and isolates payment variance trends and discrepancies, escalates as appropriate.
4.  Corresponds with third party payers, hospital departments, and patients to obtain information required for payment variance resolution. Clearly documents all actions taken during the resolution process.
5.  Applies reimbursement concepts while researching and triaging payment variance.
6.  Troubleshoots payer issues and increase understanding of payment variance resolution techniques utilizing reference material. References payer websites as needed.
7.  Analyzes and manages outstanding credit balances and resolves through posting corrections, refunds, and retraction requests. Identifies coordination of benefits variances and appropriately identifies primary payer.
8.  Updates account insurance information as needed to allow correct recalculation, resolving the variance and escalates trends.  
9.  Adjusts account balances using correct transaction, code adhering to guidelines.  
10. Submits appeals utilizing payers preferred method, i.e., electronically or via paper.
11. Maintains current knowledge of payer payment policies, changes, and revisions. Utilizes payer websites to research payer payment policies. 
12. Remains current on basic coding principles (i.e. modifiers). Understands billing requirements.
13. Meets established productivity standards.
14. Participates in cross training to optimize resources.
15. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
16. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
17. Maintains and fosters an organized, clean, and safe work environment.

II. Position Qualifications:

License/Certification/Education:

Required:
1. High School diploma 

Experience/Skills:

Required:
1. Two or more years of experience in health care billing functions.
2. Knowledge and experience with health care revenue cycle systems and billing tools.
3. Proven track record of successful performance and goal achievement.
4. Ability to perform assigned tasks efficiently and in timely manner. 
5. Ability to work collaboratively and effectively with people. 
6. Exceptional communication and interpersonal skills.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.