Underpayment Analyst

This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Review hospital claims to ensure accurate reimbursement.

• Detect discrepancies between anticipated and actual reimbursement figures from insurance providers using company best practices, technology-driven worklists, and internal tools.

• Examine payment variances, coding mistakes, billing inconsistencies, and incorrect application of payer policies.

• Reach out to insurance companies to gather missing information, clarify and resolve underpayments, and facilitate payment or adjustment processing on behalf of clients.

• Draft and submit letters, emails, faxes, online inquiries, appeals, adjustments, reports, and payment postings.

• Keep records of underpayment root causes, trends, outcomes, and lessons learned.

• Engage in discussions, meetings, and brainstorming sessions to enhance processes.

• Adhere to ethical standards and comply with applicable regulations and organizational policies.

• Undertake additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is a must.

• Investigative and problem-solving skills to detect underpayments and discrepancies.

• Understanding of healthcare billing, coding, and reimbursement practices.

• Strong analytical skills to interpret complex guidelines and their ramifications for claims reimbursement.

• Capability to navigate and comprehend Medicare, Medicaid, and Commercial insurance payer policies.

• Detail-oriented mindset for precise guideline application and documentation for audit and compliance purposes.

• Excellent communication abilities for collaboration with internal teams, payers, and external stakeholders.

• Experience with healthcare billing software and databases, including EPIC, Cerner, and Meditech.

• Knowledge of HIPAA, CMS regulations, and state-specific healthcare reimbursement standards.

• Moderate computer skills with MS Excel, Word, and Outlook.

• Technical proficiency in managing multiple computer screens and software applications simultaneously.

• Prior experience working in a remote setting.

• A quiet, distraction-free home work environment.

• Secure home internet connection with download speeds exceeding 20 Mbps and upload speeds above 10 Mbps.

• Workspace that accommodates workstation equipment and necessary materials.

• Must reside in the United States within one of the specified states.

• Employment eligibility in the United States.

• Successful completion of a background check.

🏝️ Benefits

• Comprehensive training starting on the first day and lasting 90 business days.

• Remote work opportunity.

• Work-from-home configuration.

• Requirements for secure home internet connection and home workspace.

• Equal employment opportunity workplace.