Be the person who makes sure the money matches the contract, because “close enough” does not pay hospital bills. If you love digging into details, spotting patterns, and winning disputes with facts, this is your lane.
About Prisma Health
Prisma Health is a large healthcare system focused on transforming care for the communities it serves. Their revenue cycle teams help ensure claims are processed accurately and reimbursement aligns with payor contracts and policies.
Schedule
- Remote
- Full-time
- Day shift (United States of America)
What You’ll Do
- Review payor payments to ensure claims are paid correctly according to negotiated contract rates
- Identify underpayments and submit payment discrepancy disputes when appropriate
- Collaborate across departments to process appeals and resolve underpayments using contract terms and fee schedules
- Research insurance credit balances and adjustments to ensure transaction accuracy and proper disbursement
- Review payor refund requests and resolve reimbursement discrepancies through appeals or adjustments
- Troubleshoot claim pricing issues in Prisma Health systems and recommend improvements
- Track and report trends related to payor behavior, reimbursement patterns, and contract performance
- Meet departmental productivity and quality standards and escalate issues when appropriate
- Support training and process improvement efforts related to appeals, contracting, and revenue cycle impacts
What You Need
- High school diploma or equivalent (or post-high school diploma/highest degree earned)
- 5+ years of bookkeeping, invoice/account reconciliation, or healthcare revenue cycle/medical office experience
- Managed care, payor contracting/reimbursement, denials, and/or appeals experience (preferred)
- Strong communication skills and ability to work autonomously
- Advanced Excel skills (including pivot tables and other functions)
- Strong critical thinking and analytical skills with the ability to prioritize workload
- Working knowledge of CPT and DRG coding practices
- Working knowledge of billing requirements for government and commercial payors
- Ability to problem-solve quickly and escalate appropriately
- Bachelor’s degree plus 2 years of related experience may be considered in lieu of the above experience
Benefits
- Not listed in the posting (review Prisma Health benefits details during the application process)
If you’re the kind of person who can’t ignore a mismatch on a spreadsheet, don’t let this one pass you.
Bring your precision and go get paid for it.
Happy Hunting,
~Two Chicks…