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RCM Claims Variance Analyst, Full Time

RCM Claims Variance Analyst, Full Time

Hialeah HospitalHialeah, FL, USA
1 day ago
Job type
  • Full-time
  • Quick Apply
Job description

POSITION SUMMARY

Under the director of the CBO Director, the RCM Claims Variance Analyst is responsible for reviewing, analyzing and reconciling variances between expected and actual reimbursement, as well as resolving administrative denied claims. This role analyzes denial reasons, corrects claims errors, submits appeals and collaborate with internal departments to prevent recurring denials. The analyst identifies trends and prepares weekly reports to CBO Director.

KEY RESPONSIBILITIES

  • Review denied and underpaid claims and determine appropriate action.
  • Analyze denial codes and payer responses to identify root causes and resolution strategies.
  • Analyze remittances and compare paid amounts to contracted reimbursement rates and expected payment models.
  • Investigate root causes of variances (contract errors, coding issues, claims edits)
  • Track and report recovery amounts and payer performance metrics.
  • Maintain up-to-date knowledge of Medicare, Medicaid and Commercial payer requirements.
  • Prepare and submit appeals with supporting documentation within payer timeframe.

QUALIFICATIONS AND EXPERIENCE

  • Minimum of 2-5 years' experience in revenue cycle, reimbursement analyzes, or billing.
  • Strong understanding of managed care contracts and payment methodologies.
  • Knowledge of payer denial codes, claim adjudication and billing regulations.
  • Knowledge of Medicare, Medicaid and Commercial Reimbursement.
  • Ability to read and interpret payer contracts and payment rules.
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    Rcm • Hialeah, FL, USA