Payment Reviewer
Our client, a White Plains, NY-based medical facility, seeks a
Temp to Perm Payment Reviewer. Please review this opening and let me know if you want your resume submitted.Temp to Perm Payment Reviewer
Department/Location: Patient Accounts
Reports to: Supervisor, Patient Accounts
Pay up to $30
Position Summary - Reviews all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and HIS expected reimbursement amount to ensure appropriate reimbursement.
- Takes necessary action to resolve account variances and ensure adherence to contract terms.Essential Functions and Responsibilities Include the Following:
- Understands and adheres to the client's Performance Standards, Policies, and Behaviors
- Reviews third-party remittance advice to ensure proper payment was received from insurance carriers based on contract arrangement
- Reviews HIS to ensure the expected reimbursement amount is the amount received by the insurance carrier
- Takes necessary action on any reimbursement discrepancies to ensure payments adhere to contract rates and terms
- Research and initiate refunds to patients or insurance carriers as needed
- Sends inquiries to patients regarding inaccurate or incomplete information
- Escalates issues to management and provider representatives regarding incorrect payer processing and/or contract issues
- Completes charge adjustments and allowances entries on accounts as needed
- Recodes accounts by insurance carrier and plan number and enters into the HIS for rebilling purposes
- Processes rejections on accounts denied by insurance carriers
- Assists with telephone calls as needed
- Contacts insurance carriers as needed for additional payment and or credit resolution
- Performs all other related duties as assigned
- HBI certification is required prior to the end of the probationary period
