Variance HMS Specialist

Apply for JobJob ID90826LocationAurora, ColoradoFull/Part TimeFull-TimeRegular/TemporaryRegularAdd to Favorite JobsWhy Work at Children's.Here, it's different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare

excellence for more than 100 years.

Here, the nation's brightest nurses, physicians, scientists,

researchers, therapists, and care providers are creating the future of

child health. With an optimist's outlook, a trailblazing spirit, and a

celebrated history, we're making new strides every day.

We've been Magnet-designated four times by the American Nurses Credentialing

Center and are consistently recognized among the best of the best pediatric

hospitals with #1 rankings in Colorado and the region by U.S. News & World

Report.

As a national leader in pediatric care, we serve children and families from

all over the nation. Our System of Care includes four pediatric hospitals,

11 specialty care centers, 1,300+ outreach clinics and more than

10,000 healthcare professionals representing the full spectrum of pediatric

care specialties.

Here, we know it takes all of us, every role, to deliver the best

possible care to each child and family we treat.

That's why we build our teams toward a foundation of equity in access,

advancement, and opportunity. We know teams of individuals with different

identities and backgrounds can nurture creativity and innovation. We know we

can see, treat, and heal children better when our team reflects the

diversity of our patient population. We strive to attract and retain diverse

talent because we know a truly inclusive and equitable workforce will help us

one day realize our most basic calling: to heal every child who comes

through o

A career at Children's Colorado will challenge you, inspire you, and

motivate you to make a difference in the life of a child. Here, it's

different.Job OverviewThis 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.Additional InformationDepartment Name: Patient Financial Services

Job Status: Full time 40 hours per week.

Shift:Day shift flexible hours from 6am to 6pm.QualificationsEducation: High School Diploma or equivalent required.

Experience: Minimum five (5) years of healthcare and/or accounts

receivable experience.ResponsibilitiesPOPULATION 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 a d/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.