Job Location : Orlando,FL, USA
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries.
Working at Abbott
At Abbott, you can do work that matters, grow, and learn, care for yourself and your family, be your true self, and live a full life. You'll also have access to:
The Opportunity
This position works out of our Orlando, FL location in the Heart Failure Division. In Abbott's Heart Failure (HF) business, we'redevelopingsolutions to diagnose, monitor and manage heart failure, allowing people to restore their health and get on with their lives.
The Payment Review&Administration SME is responsible for leading the review and analysis of healthcare payments received to ensure proper application andaccuracy. This role coordinates with insurance payers and internal departments to resolve payment discrepancies, patient refunds, and prepares documentation for internal, QC remediation, and external payer audits. The SME will support training and onboarding initiatives, assist indevelopingand enhancing standard operating procedures, and contribute to process improvement initiatives across the payment review and administration functions.
What You'll Work On
Analyze and validate payment data to ensure accurate posting and identify underpayments, overpayments, or contractual discrepancies.
Coordinatewith insurance payers to resolve payment variances and request necessary adjustments, refunds, or supporting documentation.
Prepare, validate, and submit patient refund packets in accordance with payer policies and company guidelines.
Develop and maintain internal documentation to support payer audits, including compiling remittance advice, EOBs, medical documentation, and internal reconciliations.
Act as a subject matter expert and resource for escalated payment or refund questions across departments.
Facilitate training sessions for new and existing staff, ensuring consistent understanding of policies, tools, and workflows.
Collaboratewithcross-functional teams(Billing, Collections,Cash Posting, and Compliance) to identify and implement workflow enhancements.
Assist in the creation, documentation, and refinement of standard operating procedures (SOPs) related to payment review, administration, andaudit support.
Monitor trends in denials, refunds, and payment patterns to proactively identify areas of concern or improvement.
Support quality assurance efforts by auditing payment records and refund documentation for compliance andaccuracy.
Collaboratewith RCM department leads to review QC remediation items, ensure timely resolution, and document any identified process gaps or necessary changes.
Data collection and reporting
Maintain payer review trending analytics and report to the management.
General support
Perform other duties as assigned.
Required Qualifications
Preferred Qualifications
Apply Now
Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives:www.abbottbenefits.com
Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity.
Connect with us atwww.abbott.com, on Facebook atwww.facebook.com/Abbott, and on Twitter @AbbottNews.
The base pay for this position is $75,300.00– $150,700.00. In specific locations, the pay range may vary from the range posted.