Note: Office for this position is located at our Continuing Care Hospital: 701 S. Fry Rd. Katy, TX 77450.

*Strong analytical skills, attention to detail, and knowledge of healthcare billing practices

*Three years of experience working in healthcare contract compliance

*Experience of resolving healthcare insurance payments discrepancies

*Knowledge of credit balance (refunds) resolution is preferred

*Revenue Cycle experience is a plus

At Houston Methodist, the Payment Variance Specialist position is responsible for ensuring that all claims are paid at contracted rates by researching and resolving payment variances for all applicable payors, with the goal of maximizing reimbursement for the services provided by Houston Methodist. This position is responsible for understanding healthcare contracting terms and requirements in order to address underpayments and denials in accordance with regulatory and contractual obligations. This includes contract content review, application of appropriate contract terms and fee schedule(s), and a thorough understanding of the requirements of the Government and Non-Government payment policies and payor contracts. Additionally, this position identifies accounts with payment review opportunities, appropriately communicating with payors and/or Managed Care regarding contract compliance responsibilities and resolving reimbursement discrepancies. The Payment Variance Specialist is also responsible for identifying trends and reporting issues to the appropriate leadership for the purpose of enforcing Payor Contract Compliance. This position works both independently and as a part of the Accounts Receivable Team, as well as with other teams within revenue cycle and throughout the health system.

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results.

• Strikes a balance between maintaining trustful relationships and ensuring timely payments. Exhibits professionalism and trustworthiness.

SERVICE ESSENTIAL FUNCTIONS

• Utilizes understanding of healthcare contracting terms and requirements in order for underpayments and denials to be addressed in accordance with regulatory and contractual obligations.

• Ensures that all claims are paid at contracted rates by researching and resolving payment variances for all applicable payors.

• Identifies trends by looking for patterns when the payor pays incorrectly and reports issues to the appropriate leadership for the purpose of enforcing Payor Contract Compliance.

• Documents all actions and encounters in the patient accounting system using standard codes.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Provides clear and concise documentation of every action taken on an account in the system collection notes. Provides balance breakdown to document the status of next responsible party (i.e., primary, secondary payor, patient balance, or credit balance).

• Identifies accounts for advanced due diligence steps or legal placement by following defined department standards of actions required to bring the account to resolution in accordance with department policy and procedure. Effectively manages inventory in accordance with departmental standards.

• Utilizes contracting modeling and notifies manager if incorrect payments/contractuals are being calculated.

• Meets or exceeds stated Performance Indicator Expectations (e.g., productivity, account reviews, agings) as demonstrated on weekly Key Performance Indicator.

FINANCE ESSENTIAL FUNCTIONS

• Follows up on assigned delinquent insurance claims. Ensures maximization of collection dollars from insurance companies in accordance with the respective contract and/or Houston Methodist financial arrangement.

• Reviews accounts for errors, adjustments and credits, issuing corrected entries when necessary by following defined expectations outlined to resolve the account. Updates account information accordingly. Follows levels of authority for posting adjustments, refunds, and contractual allowances.

• Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on various payors and industry trends. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.

• Generates and communicates new ideas and suggestions that will improve quality or service. Demonstrates adaptability and flexibility in the face of changing demands.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

• Bachelor's degree (preferably in business administration, finance, healthcare administration, or related discipline) or additional four years of experience (in addition to the minimum experience requirements listed below) in lieu of degree

WORK EXPERIENCE

• Three years of experience working in contract compliance or revenue cycle environment

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc.; knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation

• Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process

• Understanding of revenue cycle fundamentals

• Ability to follow-through and handle multiple tasks simultaneously

• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff

• Good judgment in handling of accounts and ability to apply a professional approach in dealing with patients and insurance companies

• Sharp analytical abilities in order to resolve patient accounts in a timely and correct manner

• Proficient computer skills and ability to learn and navigate multiple software programs

• Ability to remain calm in stressful situations with patience and understanding

• Ability to approach problems with an open mind and contribute to solutions

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No

• Scrubs No

• Business professional Yes

• Other (department approved) Yes

ON-CALL*

*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL

Travel specifications may vary by department

• May require travel within the Houston Metropolitan area No

• May require travel outside Houston Metropolitan area No

Company Profile:

Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.

Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.

Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.