Payment Variance Specialist - Physician Revenue Cycle

Job Family:

Patient Account Representative

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

What You Will Need:

• 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.

What Would Be Nice To Have:

• 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

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The annual salary range for this position is $38,000.00-$64,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• 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

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.