PFS Contract Variance Analyst, Denials Analysis

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<p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><b style="mso-bidi-font-weight:normal;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong><u>SUMMARY<o:p></o:p></u></strong></span></b></span></p><p class="MsoNormal"><span style="background-color:white;color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">We are currently seeking a </span></span><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-ansi-language:EN-US;mso-bidi-font-size:18.0pt;mso-bidi-language:AR-SA;mso-fareast-font-family:" times="" new="" roman";mso-fareast-language:en-us;"=""><strong>PFS Contract Variance Analyst</strong></span></span><span style="background-color:white;color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong> </strong>to join our Denials Analysis team. This full-time role will work remotely (Days, M- F).  </span></span><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><o:p></o:p></span></span></p><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><o:p></o:p></span></span></p><p><span style="background-color:white;color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-ansi-language:EN-US;mso-bidi-font-family:" calibri="" light";mso-bidi-language:ar-sa;mso-bidi-theme-font:major-latin;mso-fareast-font-family:calibri;mso-fareast-language:en-us;mso-fareast-theme-font:minor-latin;"=""><strong>Purpose of this position:</strong> </span></span><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-ansi-language:EN-US;mso-bidi-font-size:10.0pt;mso-bidi-language:AR-SA;mso-fareast-font-family:" times="" new="" roman";mso-fareast-language:en-us;"="">The Contract Variance Analyst provides foundational support in managing appeals related to payer contract variances and fatal denials. This role is responsible for assisting with appeal documentation, tracking, and submission processes, while collaborating with internal teams to gather necessary information. The analyst maintains data accuracy within tracking systems, prepares routine reports, and participates in training and process improvement initiatives. This position offers an opportunity to build expertise in revenue cycle operations and payer relations while ensuring compliance with organizational and regulatory standards.</span></span></p><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><b style="mso-bidi-font-weight:normal;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong><u>RESPONSIBILITIES</u></strong></span></b></span></p><ul><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Supports the Contract Variance Appeal process by assisting with intake, documentation, and tracking of appeals submitted to third-party payers</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Prepares and submits appeals to third-party payers under guidance, monitors status updates, and follows up to ensure timely resolution</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Conducts basic research to support appeal documentation and stays informed on payer updates and policy changes</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Collaborates with internal teams to gather necessary information for appeal resolution</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Maintains and updates tracking systems, ensuring accurate data entry and assisting with report generation</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Compiles and organizes data to help identify trends in contract variances and denials</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Prepares standard reports and summaries for review by senior analysts and leadership</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Escalates complex issues to senior team members and participates in team discussions to support problem-solving</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Participates in team-based quality and process improvement initiatives to enhance workflows and outcomes</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Ensures compliance with HIPAA, organizational policies, and applicable regulations in all work activities</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Demonstrates professionalism and attention to detail in communications and documentation</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Assists with system testing and documentation updates related to Contract Variance workflows</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Engages in training and development opportunities to build knowledge and skills relevant to the role</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Supports the appeals process by helping assess and document Contract Variances and Fatal Denials under supervision</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Updates performance dashboards, verifying data accuracy and completeness</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Prepares meeting materials and gathers documentation for leadership review</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Maintains a positive, team-oriented approach, contributing to a collaborative work environment</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Performs other duties as assigned to support the Contract Variance team and department goals</span></span></li></ul><br><br><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><b style="mso-bidi-font-weight:normal;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong><u>QUALIFICATIONS:<o:p></o:p></u></strong></span></b><i style="mso-bidi-font-style:normal;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;mso-themecolor:accent5;"=""><o:p></o:p></span></i></span></p><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><i><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong>Minimum Qualifications:</strong></span></i></span></p><ul><li><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;">Bachelor’s degree in Business, Finance, Health Care Administration, or related field </span></p></li><li><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;">1 year of experience in healthcare contract variance analysis, including an in-depth knowledge of healthcare claims processing</span></p><p class="MsoNormal"><br><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;">-OR-</span></p></li><li><p class="MsoNormal"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;">An approved equivalent combination of education and experience</span></p></li></ul><p class="MsoNormal" style="mso-layout-grid-align:none;text-autospace:none;"> </p><p class="MsoNormal" style="mso-layout-grid-align:none;text-autospace:none;"><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><i><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong>Knowledge/ Skills/ Abilities:</strong></span></i></span></p><ul><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Excellent problem solving skills</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Knowledge of EPIC claims processing systems and electronic health records</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Must have skills in data analysis and associated tools</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Proficiency with Microsoft Office</span></span></li><li><span style="color:black;font-family:Verdana, Geneva, sans-serif;font-size:14px;"><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"="">Proficient with database reports (Clarity, EPIC workbench, etc)</span></span></li></ul><p class="MsoNormal" style="mso-layout-grid-align:none;text-autospace:none;"><span style="color:black;font-family:" verdana",sans-serif;"=""><i><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong><o:p></o:p></strong></span></i></span><span style="font-family:" verdana",sans-serif;"=""><i><span style="mso-bidi-font-family:" calibri="" light";mso-bidi-theme-font:major-latin;"=""><strong><o:p></o:p></strong></span></i></span></p>

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