Campus Pride Jobs

Description Monitors the compliance of all major payers with health service contract reimbursement terms and payment provisions. Researches and identifies underpayment patterns and escalates issues to Manager as appropriate. Appeals and resolves insurance underpayments as directed by Manager. Recommends process improvements to maximize coding and billing, and provides support to departments directly responsible for contracting, coding, registration, referral management, revenue posting, and patient financial services. The scope of this position includes patient service revenue generated within Pacific Medical Centers. This position reports to the Revenue Cycle Manager. Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: 4 years progressive healthcare business office or health insurance experience. Experience in healthcare financial services. Preferred Qualification: Associate's Degree, or equivalent from a two-year college or technical school. Essential Functions: Investigate, research and maintain accurate definitions of contractual rates within SPD contract management system. Utilize and maintain contract management system workflows including external reports to support reimbursement analysis, ensuring that insurance payments are consistent with contractual obligations. Maintain current knowledge regarding reimbursement mechanisms within the healthcare industry. Demonstrate a sophisticated understanding of confidentiality and exercise discretion regarding reimbursement rates and contract terms for various entities as directed by Manager. Develop and maintain effective relationships with provider relations representatives and participate in payer operations meetings when necessary. Identify, communicate and report on underpayment issues, undercharged services, bundling, and other reimbursement opportunities. Work with coding or business office leadership to ensure that corrective action is taken where appropriate. Investigate and research claims variances in SPD contract management system, and pursue recovery of underpayments by compiling and submitting detailed claims appeals as directed by Manager. Work strategically to prioritize projects, and track the status of each appeal, following up with payer representatives as necessary to ensure accurate and timely reprocessing of claims paid incorrectly. Utilize tracking mechanisms to support the interdepartmental coordination of payer compliance related functions and related transactions, such as reason and status coding within payer compliance system. Identify and recommend enhancements for coding, registration, referral management, and any other opportunities that may improve reimbursement, to business office, providers, and clinic operations staff and management. Support implementation of recommended change as necessary. Communicate potential system enhancements and reimbursement process quality improvement opportunities to Manager. Maintain and achieve departmental production measures and standards and goals. Meet deadlines and goals established for underpayment recoveries, including timely and regular follow-up of outstanding appeals and projects. Identify departmental and organizational problems and collaborate with Manager to resolve them. Demonstrate excellent communication skills in either group or individual settings, in verbal and written format. Complete appropriate and timely responses to internal and external customers as they pertain to areas of responsibility. Perform other specific pr