[Hiring] Payment Variance Specialist @Guidehouse

Role Description

The Payment Variance Specialist (Physician Revenue Cycle) is responsible for identifying, investigating, and recovering discrepancies between the expected reimbursement from insurance payers and the actual payment received for physician and professional services. This position will follow and ensure that client and company policies and procedures are followed and will also perform all job-related duties as assigned.

• Strong Physician Claims Payment Variance & A/R Follow-up
• Variance Identification & Analysis:
  • Compare paid claims against managed care contracts, fee schedules, and expected rate matrices to flag underpayments, overpayments, and unapplied contractual adjustments.
• Payer Disputes & Appeals:
  • Initiate formal disputes, follow up on open inventory, and draft appeals with commercial or government insurance companies to recover lost revenue.
• Root Cause Analysis:
  • Investigate why errors occurred (e.g., system configuration/contract load errors, coding mistakes, or payer pricing errors) and work with internal teams to fix the source.
• Credit Balances & Overpayments:
  • Handle insurance and patient refunds or credit balance reporting in compliance with regulations like Medicare guidelines.
• Reporting & Collaboration:
  • Track recurring underpayment trends, maintain aging inventory reports, and communicate financial impact to revenue cycle leadership.
  • Strong understanding of all software/systems used.
  • Identify, validate, and report project trends/issues.
  • Updating of spreadsheets, monitoring outstanding items for each client, and providing updates to leadership, client, and team.
• All job-related duties as assigned.

Qualifications

• High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED.
• 1-3+ year's experience in office, business, operations, customer service, healthcare payor, provider, revenue cycle, or professional services environment.

Requirements

• Strong physician claims payment variance background.
• Demonstrated proficiency in relevant revenue cycle processes with high production and quality standards.
• Strong verbal and written communication skills to effectively communicate with staff and client.
• Demonstrated proficiency interpreting relevant coding systems including, but not limited to, CPT and HCPCS and ICD-10 in a fast-paced environment.
• Demonstrated leadership qualities fostering team cohesion, accountability, and high performance.
• Demonstrated proficiency researching billing guidelines.
• Demonstrated skills providing training and mentoring to team members.
• Act as a role model for team, office, and company.

Benefits

• Medical, Rx, Dental & Vision Insurance.
• Personal and Family Sick Time & Company Paid Holidays.
• Position may be eligible for a discretionary variable incentive bonus.
• Parental Leave.
• 401(k) Retirement Plan.
• Basic Life & Supplemental Life.
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts.
• Short-Term & Long-Term Disability.
• Tuition Reimbursement, Personal Development & Learning Opportunities.
• Skills Development & Certifications.
• Employee Referral Program.
• Corporate Sponsored Events & Community Outreach.
• Emergency Back-Up Childcare Program.