Underpayment Analyst
Remote-USAFull-TimeMiddle
Salary not disclosed
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Job Details
- Required Skills
- Microsoft ExcelMicrosoft OfficeHIPAA
Requirements
- Want to grow a career
- Have a working knowledge of Microsoft Office (Word, Excel, Outlook)
- Possess technical proficiency to work on multiple computer screens and software applications simultaneously
- Can maintain strong performance in a fast-paced environment with productivity metrics
- Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies
- Have a working knowledge of healthcare billing, coding, and reimbursement methodologies
- Can navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines.
- Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech)
- Have familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.
Responsibilities
- Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers.
- Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
- Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client.
- Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting.
- Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
- Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
- Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities.
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