Contract Variance Director (Job # 4188)

New York Metro Area

Post Date: 06/13/2017 Job ID: 4188 Department: Financial Services

Contract Variance Director

New York City

10026            

Hiring Variance Director for a top teaching hospital. The Contract Variance Director is primarily responsible for the collection and follow up of all Commercial revenue in addition to the development and implementation of all functions related to contract management and compliance related to all health plans. The Contract Variance Director position requires the creation of and management of all contracts within the EPIC billing system to ensure that revenue is accurately stated in the receivable while, tracking, recording and reporting on the resolution of payment variances that fall under the hospital and all its entities.

Responsibilities
  • Create and maintain all contract logic in the EPIC system as well as creating ‘ profiles’ in EPIC
  • Run and maintain quarterly reserve files related to both denial management as well as cost outliers
  • Analyze receivable by HMO for trends where reimbursement can be improved
  • Attend bi-monthly JOC meetings with receivable managers
  • Conduct analysis of variance for inpatient and outpatient receivables
  • Develop financial models to track and monitor receivables to respond quickly to negative changes
  • Resolve inpatient and outpatient claims variance
  • Perform internal audits to verify contracted rates are paid by health plans
  • Analyze receivable by HMO for trends where reimbursement can be improved
  • Compile and analyze claims for agreed, settled time-periods between facility and contracted health plans.
  • Oversee and delgate inpatient and outpatient implant charges.
  • Test NYS and Federal DRG Groupers.
  • Oversee inpatient and outpatient health plan refunds and processes.
  • Create and delegate files to staff throughout department for claim follow-up and reconciliation of denied claims
  • Develop reporting mechanisms for management to track and trend denials within HMO/Commercial receivable.
  • Provide operational and analytical support to Management
  • Maintain working relationships with payers, IPRO, DOH and other outside agencies

Requirements
  • Bachelor’ s degree
  • Understanding of hospital receivable as it relates not only to payment variances as well as follow up and denials
  • Understanding of denials related to Utilization Management, and how to properly asses a risk analysis report.
  • Knowledge of contract management and a thorough understanding of contract language (timely filing, fee schedules, case rates, denial provisions) as well as knowledge of EPIC and how to properly code contracts.
Apply Online

Not ready to apply?

Send an email reminder to:

Share This Job:

Related Jobs: