El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen.

Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.

FTE

Scheduled Bi-Weekly Hours

Work Shift

Job Description

The Payment Resolution Specialist performs managed care insurance payment audit/underpayment identification, research, analysis, reporting, and collections functions. Ensures claims are paid appropriately pursuant to negotiated payment rates in El Camino Hospital's contractual agreements with managed care insurance payers. Reports all significant underpayment issues, trends, and systemic issues to Revenue Cycle Senior Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. Keeps informed of managed care and contractual arrangements in order to resolve and process accounts by managed care insurance payers. Follows up on all payment variances for account resolution through insurance payer's online tools, phone calls, and periodic in-person meetings with insurance payer liaisons. Collaborates closely with the Contracting Services Department to facilitate escalation of significant and systemic insurance payment issues. Ensure all accounts are resolved in a compliant manner and according to all applicable hospital policies/procedures, rules, and regulations. After multiple unsuccessful appeal attempts, the Payment Resolution Specialist is tasked with carefully evaluating all factors and exercising prudent decision making to determine whether to continue or cease pursuit of insurance payment, subject to specific dollar threshold(s) outlined in hospital policies and procedures.

Qualifications

High School Diploma or equivalent

Minimum of five (5) years related work experience in a Hospital Billing setting

Minimum of three (3) years related work experience involving interpretation/analysis of managed care contract payment terms

Strong critical thinking and analytical skills

Strong verbal and written communication skills

Proficient in HMO, PPO, Managed Medicare, Managed Medi-Cal, and 3rd party rules and regulations

Proficient in managed care contracting payment terms and rate structures for hospitals

Works in a collaborative and team manner

Basic to intermediate skill level in Microsoft Excel (Microsoft Access is a plus)

Salary Range:

The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.