Variance Denials Specialist

This is an advanced-level variance (credit and/or debit) position within the Patient Financial Services team. The position ensures reconciliation of patient accounts with enhanced EOB/insurance processing understanding, accurate and timely response to payers' correspondence, advanced credit account review with understanding of contract summaries and application to account types, and collaboration with across Revenue Cycle and appropriate departments on accounts during discrepancies. Has in depth ability to recognize deviations from contractual expectation and payor activities or decisions, recognize gaps in payment/reasoning or system errors and handle escalated, complex accounts, and is capable of auditing accounts for accuracy and working accounts to completion/resolution. Identifies trends or gaps where appropriate and follows through to ensure solutions.

Department Name: Patient Financial Services
Job Status: Full time 40 hours per week.
Shift:Day shift flexible hours from 6am to 6pm. Hybrid

• Education: High School Diploma or equivalent required.
• Experience: Minimum five (5) years of healthcare and/or accounts receivable experience.

POPULATION SPECIFIC CARE No direct patient care.
ESSENTIAL FUNCTIONS
An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.
* Reads and interprets EOB/insurance processing to understand and work and resolve accounts.
* Reads, understands, and interprets contracts and contract summaries to advise correct applications for an account.
* Recognizes and solves for deviations from contractual expectation and payor activities/decisions, recognize gaps in payment/reasoning or system errors.
* Will work projects such as Novita's, Medicaid and Medicare Audits, HMS. Supports and completes audit processes.
* Investigates and resolves assigned credit and/or debit balance accounts. Issue insurance refunds when appropriate.
* Calculates, corresponds on, and corrects contractual adjustments based on insurance contracts.
* Intermediate trending and analysis - identifying root cause and solution-oriented mindset. Recognize and call out trends within payers and escalate as appropriate.
* Proficiently discusses accounts, records, and service with patients/insurance, as needed.
* Collaborates with patients, vendors, and internal departments to resolve conflicts on accounts and resolve any outstanding credit and/or debit balances of unapplied/unidentified payment receipts.
* Identifies and prioritizes accounts and WQs, based on scoring, type, payor, dollar, etc.
* Understanding and investigation into account based on contract segments, types of accounts (i.e. outpatient, inpatient, series, etc.), thresholds, Single Case Agreements, and other requirements/components.
* Ensures accuracy in credits and/or debits processing while adhering to all regulations, objectives, operating policies and procedures, and strategic action plans for achieving goals.
* Compiles and maintains various documentation and other reporting requirements.
* Prints and mails any required hard copy forms to insurance companies, including recoupment letters, etc.

SCOPE & LEVEL
Guidelines: Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent.
Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion.
Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.
Communications: Contacts with team members, clients or the public where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function. Supervision Received: Performs work with minimal supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.

Ability to Perform Essential Functions of the Job

PHYSICAL REQUIREMENTS
Audio-Visual: Hearing: Good
Audio-Visual: Near Vision: Good
General Activity: Sit: Up to 2/3 of time
Motion: Bend: Up to 1/3 of time
Use of Hands/Feet: Precise Motor Function
Weight Lifted/Force Exerted: Up to 30 pounds
WORK ENVIRONMENT
Mental and Emotional Requirements: Independent discretion/decision making.
Mental and Emotional Requirements: Makes decisions under pressure.
Mental and Emotional Requirements: Manages stress appropriately.
Mental and Emotional Requirements: Works with others effectively.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.