Title:  Claim Variance Analyst

Division:  Baylor MedCare
Schedule:  Monday - Friday, 8:00 a.m. - 5:00 p.m.
Work Location:  Greenway Plaza, Houston, TX
Salary Range:  $50,251 - $57,750
FLSA Status:  Exempt
Requisition ID:  1476
Job Purpose

Responsible for monitoring managed-care contractual allowances; analyzing, trending and pursuing appeal opportunities with payers and networks; reporting appeals performance.

Job Responsibilities

•    Defines and utilizes process for identifying under-allowed claims using Experian Contract Management and other available tools.
•    Reviews and analyzes EOBs for identified under-allowed claims.
•    Verifies applicable managed-care contract by reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans.
•    Prepares written and telephone appeals.
•    Batches appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider.
•    Identifies trends, compiles and submits appeals, and monitors for proper reimbursement.
•    Tracks appeals and recoveries.
•    Establishes and utilizes follow-up protocol with payers and networks.
•    Prepares monthly performance statistics regarding appeals and recoveries.
•    Monitors and tracks contractual, billing, registration, and posting errors.

Minimum Qualifications
Education:
  • Required: Bachelor degree in related field. 

Experience:
  • Required: Two years of relevant experience. 

Certification/Licenses/
Registration:
  • Required: None.

 

 

 

 

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

 1476