Payer Underpayment Recovery Specialist

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Identify potential underpayments from payers by analyzing payment data, contractual allowed amounts, fee schedules, EOBs/ERAs, payer policies, claim history, and anticipated reimbursement calculations.

• Utilize Rivet, Modernizing Medicine, Athena, Excel, and payer portals to investigate discrepancies in reimbursement.

• Confirm underpayment opportunities by comparing actual payments against contracted rates.

• Research payer contracts, fee schedules, and reimbursement methodologies.

• Create comprehensive documentation packages to support payer reconsideration requests.

• Submit disputes regarding underpayments, requests for reconsideration, appeals, and inquiries to payers within established timelines.

• Monitor underpayment cases from discovery to resolution.

• Maintain Excel-based spreadsheets and trackers to oversee underpayment opportunities.

• Collaborate with billing, coding, payment posting, payer collections, contracting, and revenue integrity teams to address payment discrepancies.

• Identify trends by payer, CPT code, modifier, provider, practice, location, system, or contract term and escalate recurring issues.

• Assist in reporting on underpayment recovery, revenue impact, payer trends, aged cases, overturn rates, and opportunities for process improvement.

⛳️ Requirements

• Experience in the healthcare revenue cycle, payer collections, reimbursement analysis, contract variance review, payment posting, denials, or revenue integrity.

• Proficiency in using Rivet, Modernizing Medicine, Athena, Excel, and spreadsheet-based tracking tools is strongly preferred.

• Intermediate to advanced proficiency in Excel is required.

• Strong knowledge of EOBs, ERAs, payer contracts, fee schedules, CPT/HCPCS codes, and modifiers, as well as claim forms.

• Ability to analyze expected versus actual reimbursements and effectively articulate payment variances.

• Excellent written communication skills.

• Detail-oriented with strong organizational abilities.

• Experience with billing for orthopedic, surgical, ASC, or specialty physicians is preferred.

• Familiarity with commercial, Medicare, Medicaid, workers' compensation, bundled payment, and value-based arrangements is preferred.

• A bachelor’s degree is preferred; however, relevant experience in healthcare revenue cycle or reimbursement may be accepted in lieu of a degree.

🏝️ Benefits

• Excellent opportunities for growth and advancement.

• A dynamic work environment.

• Access to a diverse network of practitioners.

• A comprehensive array of tools and programs designed to enhance the employee experience.

• Competitive compensation.

• Generous paid time off (PTO).

• Health, dental, vision, 401(k), and more.