Payment Reviewer

Job Post Date:

02/06/2025 Req # 24657 Clerical/Administrative Support

WHITE PLAINS HOSPITAL

Patient Accounting Full Time Day M-F 8am-4pm

Salary Range:

$53,840-$80,782 Position Summary Reviews all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and HIS expected reimbursement amounts to ensure reimbursement is appropriate. Takes necessary action to resolve account variances and ensure adnce to contract terms. Essential Functions and Responsibilities Includes the

Following:

1. Understands and ads to the WPH Performance Standards, Policies and Behaviors 2. Reviews third-party remittance advice to ensure proper payment was received from insurance carrier based on contract arrangement 3. Reviews HIS to ensure expected reimbursement amount is amount received by insurance carrier 4. Takes necessary action on any reimbursement discrepancies to ensure payments ad to contract rates and terms 5. Research and initiate refunds to patients or insurance carriers as needed 6. Sends inquiries to patients regarding inaccurate or iplete information 7. Escalates issues to management and provider representatives regarding incorrect payer processing and/or contract issues 8. Completes charge adjustments and allowances entries on accounts as needed 9. Recodes accounts by insurance carrier and plan number and enters into the HIS for re-billing purposes 10. Processes rejections on accounts denied by insurance carriers 11. Assists with telephone calls as needed 12. s insurance carriers as needed for additional payment and or credit resolution 13. Performs all other related duties as assigned 14. HBI certification certificate required prior to end of probationary period Education & Experience Requirements ï‚

• High School Graduate or GED required ï‚
• Clerical experience required ï‚
• Previous hospital experience preferred ï‚
• Ability to use basic office equipment and knowledge of CTRputer terminals a plus ï‚
• Medical terminology helpful but not mandatory Core Competencies ï‚
• Ability to cooperate with others ï‚
• Must be able to speak, write understand andmunicate the English language. Effectivelymunicate with internal and external customers ï‚
• Integrity to handle the confidential aspects of work ï‚
• Retainsposure under stress Physical/Mental Demands/Requirements & Work Environment ï‚
• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) data base and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, d on a disc. ï‚
• Must be able to remain in stationary position 50% of the time ï‚
• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. ï‚
• The person in this position frequentlymunicates with insurance plans, must be able to exchange accurate information in these situations.

Primary Population Served Check appropriate box(s) below: â˜'All populations The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital. The salary range and/or hourly rate listed is a good faith determination of potential basepensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).