SCP Health · 5 hours ago
Reimbursement Variance Auditor
United States
Full-time
Remote
New Grad, Entry LevelSCP Health is a leader in clinical practice management with a focus on bringing hospitals and healers together. The Reimbursement Variance Auditor will perform retrospective reviews of accounts paid by managed care networks, acting as a liaison between various departments to coordinate appeal efforts within the Revenue Cycle.
Hospital & Health Care
Responsibilities
Provide expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
Perform third party contract reimbursement and utilization review for those policies and procedures related to the definition, identification and collection of denied or incorrect payments and management of denials of payment for the business office
Reviews reimbursement data for accuracy of payments, adjustments and contract procedures
Verify and compare reimbursement rates with existing fee schedules on file for accuracy
Provides input and recommends improvement to existing fee schedules in an effort to maximize reimbursement, improve billing efficiency and reduce accounts receivable aging
Provides guidance and/or assists billing representatives in the accounts receivable follow-up process
Analyze and identify trends for appeals and grievances
Where appropriate, aggregates underpayment trends for expedited processing
Provides feedback to manager regarding false positive and true underpayment issues
Maintain appropriate fee schedules and request system setup
Maintains a high level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with managed care companies
Utilizes payer portal websites, client patient account systems, internal technology to continually validate activity, payment accuracy, and account status
Communicate with appropriate parties issues, implications and decisions
Liaison to billing companies, payers and other necessary parties; responsible for ensuring the correction of discoveries
Maintain thorough knowledge of reimbursement regulations related to assigned region
Provide feedback to Revenue Cycle related to improvement opportunities and appeal campaigns
Ensures that company policies and procedures are current and accurately reflect processes in order to comply with regulatory requirements
Authority on impending reimbursement changes and current trends
Identifies system or procedural problems creating third party claim rejections. Formulates and implements plans for minimizing or eliminating these rejections
Assists in the performance contract reviews of third party payer agreements
Qualification
Required
Must be well organized and demonstrate effective time management skills
Excellent communication skills for working with all different levels of professionals, including executives
Must be detail oriented
Benefits
Strong track record of providing excellent work/life balance.
Comprehensive benefits package and competitive compensation.
Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
Company
SCP Health
SCP Health is a healthcare-based agency that comprises a physician-led team of clinical and operational experts.
Founded in 1994
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Rich D'Amaro
Chief Executive Officer
Rena Cottam
Chief Financial Officer
Recent News
Precedence Research
2025-11-04
Modern Healthcare
2025-05-08
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