Subject Matter Expert Payment Review

JOB DESCRIPTION:

The Payment Review Subject Matter Expert (SME)is responsible forserving as the primary resource for complex payment review cases payer reimbursement accuracy and payment variance resolution. This role supports the Revenue Cycle team by ensuring payments are reviewed accurately and in compliance with payer contracts policies and regulatory guidelines whilemaintainingestablished SLAs and quality standards.

Job Responsibilities:

• Reviews and analyzes complex high-value or escalated payment cases to ensureaccuratereimbursement.

• Validates payments against payer contracts fee schedules reimbursement methodologies and policies.

• Identifiesunderpayments overpayments and payment discrepancies;determinesroot causes and resolution steps.

• Providesexpert guidance to Payment Review Analysts on adjudication logic and reimbursement rules.

• Assistswith preparation of documentation and recommendations for appeals reconsiderations and payer disputes.

• Performs quality reviews of payment review work to ensure accuracy consistency and compliance.

• Escalates system payer or workflow issues to leadershipin a timely manner.

• Supports SOPs job aids and reference materials.
• Ensurescompliance with HIPAA and confidentiality standards.

Minimum Requirements

• Bachelorsdegree preferred.
• Minimum of 3 years of experience with focus on payment review reimbursement or contract analysis.
• Advanced knowledge of payer adjudication logic reimbursement methodologies and payment variance resolution.
• Strong understanding of claim life cycle and reimbursement principles.
• Proficiencyin RCM systems payment review tools and Microsoft Office.
• Excellent analytical communication and documentation skills.
• Strong attention to detail problemsolving skills and ability to manage highvolume workloads.

Competencies

• Fostering Teamwork

• Analytical Thinking

• Commitment to Job Deliverables

• Leadership

• Decision making

• Trustworthiness and Ethics

• Attention to Details

• Problem Solving

• Attention to Communication

• Technical Expertise

• Customer Orientation

• Analytical Thinking

• Managing Change

• Adaptability

• Managing Performance

• Stress Management

• Initiative

• Personal Credibility

• Interpersonal Skills

• Flexibility

Required Skills

• Excellent verbal and written communication skills

• Ability to communicate complex reimbursement concepts clearly

• Strong documentation and analytical commentary skills

• Team-oriented with mentoring capability

TECHNICAL SKILLS

• High attention to detail and analytical accuracy

• Strongproficiencyin Excel Word and Outlook

• Knowledge of payer fee schedules contracts and reimbursement models

• Strong computer skills and familiarity with payment review systems

PHYSICAL ABILITIES

• Perform some repetitive motion activities.
• Sit for long periods of time.
• Requires close vision and the ability to adjust eye focus often.
• Required to reach with hands and arms.

WORK SCHEDULE

• Works at a standard workstation for extended periods

• Uses standard computer equipment including keyboard and monitor

• No liftingrequiredfor this position

• Must report to work on time and complete assigned shift

• Must be willing to work night shift as required by business needs

The base pay for this position is

In specific locations the pay range may vary from the range posted.

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