MPF Underpayment Management Specialist - PFS - RCSSD

JOB SUMMARY:Audits all payments received, in conjunction with a detailed contract analysis to ensure that RCHSD MPF has received accurate reimbursement from all contracted & non-contracted payers. This includes payments from all contracted payers. Work with PFS billing staff, payer contacts, & Contracting Department to identify root cause of discrepancies in reimbursement & present issues to the appropriate level for resolution. When the terms of the contract are not properly executed, identify, analyze & recoup underpaid amounts. Provide timely communication of identified underpayment trends to department Leadership. Create all necessary reports & presentations based on department & organizational goals. Must possess proven ability to track & trend payer specific issues & report findings to department Leadership & Contracting Department to support modifications in payer negotiations. Monitors & tracks contractual, billing, registration & posting errors & provides continuous feedback to department Leadership.MINIMUM QUALIFICATIONS:H.S. Diploma,GED,or EquivalentArea of Study in a Field Related to the Position4 Years of ExperienceMedical Billing Experience RequiredMust have the ability to perform complicated mathematical calculations to adjudicate accounts appropriately.The expected hiring range for this position is $25.47 to $35.03Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.EOE including disability/vet