Compliance

• Collect Underpayment Reimbursement due for AAH Illinois hospitals and physicians from payers according to Federal/State/Local Regulations and contractual obligations
• Perform analysis of underpaid claims in order to determine appropriate course of action
• Identify and review documentation and specific account information to determine validity of underpayment
• Utilize payment variance workflow tools to initiate follow up and tracking
• Maintain strong knowledge of the requirements and contract obligations for all payers including current policies and procedures as related to payment variance management
• Document workflow tool with accurate, clear, and concise notes
• Identifies, analyzes, and researches payment variance root causes and trends
• Assists in the development of corrective action plans for resolution of underpayments and insurance credit payment variances
• Investigates and generates reports to identify all accounts applicable to a particular trend and/or root cause
• Collaborates with internal and external stakeholders to initiate corrective action plans to minimize preventable underpayments
• Monitor the progress and resolution of trends; evaluate the financial impact for the Revenue Cycle
• Identify and report new trends to management during weekly meetings
• Determine educational opportunities for underpayment trends with internal and external partners to improve processes for underpayment avoidance
• Identify insurance and patient refunds to refer to the Refund Team

Contract Compliance Specialist

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