Payment Variance Specialist

Job Number 69753
Posted 2/11/2020
Account Northern Light Health Home Office
Department Patient Financial Services
Location |ME| Northern Light Health Home Office-43 Whiting Hill Rd., ME 04412
Schedule Regular Full-time
Shift Day
Hours 8:00am-4:30pm
Job Details

This position is responsible for resolving the payment variances by all applicable payers of the EMHS Patient Account Services in a Centralized Business Office environment. This position is responsible for resolving underpayments and denials in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Government and Non-Government payment policies & payer contracts. In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of Payment Variance Specialists to analyze and take corrective action on underpayments & denials to ensure an optimum revenue cycle workflow.


· Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department's policy and procedures.

· Reviews historical payment information to determine accuracy of reimbursement.

· Reviews potential payment variances and identifies true discrepancies.

· Resolve payment disputes with payers by following appeal protocols and processes.

· Take necessary AR adjustments in accordance with the department's adjustment policy.

· Request relevant information from appropriate revenue cycle and clinical departments as required by payer.

· Advises management of payment variance issues which may require attention in a timely manner.

· Meet or exceed the EMHS performance standards as it relates to quality and productivity.

· Work closely by way of problem solving with peers and leaders to address payer underpayment and denial issues or changes that directly impact the accounts receivable.

· Ensure all functions related to underpayments and denials support the team goals and objectives as well as EMHS's financial performance objectives.

· Thoroughly understand the department's key performance indicators.

· Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.

Professional Development:

· Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars.

· Attend internal education sessions to enhance or gain new skills.


· Perform other duties as assigned.

· Adhere to the professional image of EMHS as a competent and reliable employee.


· High School diploma or equivalent required.

· 1+ year of healthcare underpayments and denials experience preferred.

· Detailed knowledge of payer regulations, principles of accounting, reimbursement concepts and automated account receivable systems.

· Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.

· Experience with EMHS patient accounting software is preferred.

· Must possess strong problem solving skills.

· Ensures all underpayment and denial functions performed are compliant with applicable laws and regulations.

· Excellent professional communication skills; both oral and written.

· Ability to understand payer policies, contracts and all applicable billing rules and regulations to facilitate decision making.

· Proficient with Microsoft business applications.

· Customer oriented.

· Demonstrated ability to work independently and collaboratively.


· Sedentary work requiring good manual dexterity.? Work involves typing, picking, grasping, occasional stooping, kneeling, crouching, lifting up to 10 lbs., reaching and ability to move about to accomplish tasks.? Require repetitive motions of wrists, hands and fingers.? Must have excellent hearing and listening skills to receive detailed information through oral communication (via telephone or in person).

· Employee subject to inside environmental conditions. Clean, well-lighted, central heat, central air conditioning. Work is performed in close proximity with others. Some noise level from office machines (printers, typewriters, telephones). Ergonomically correct work station.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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