Underpayment Analyst

This is a fully remote position, open to applicants in Alabama, +28 more locations.

📋 Description

• Review hospital claims to ensure accurate reimbursement for services rendered.

• Utilize best practices, technology-driven worklists, and internal resources to pinpoint discrepancies between anticipated and actual insurance reimbursements.

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

• Communicate with insurance providers to gather missing information, 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 healthcare reimbursement regulations, guidelines, and organizational policies.

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• Strong investigative and problem-solving skills to identify underpayments and discrepancies.

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

• Excellent analytical skills to interpret complex guidelines and their impact on claims reimbursement.

• Capability to navigate and understand Medicare, Medicaid, and Commercial insurance guidelines.

• Detail-oriented approach to applying guidelines and documenting findings for audit and compliance purposes.

• Effective communication skills for collaboration with internal teams, payers, and external stakeholders.

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

• Familiarity with HIPAA, CMS regulations, and state-specific healthcare reimbursement standards.

• Moderate computer proficiency in MS Excel, Word, and Outlook.

• Technical proficiency in using 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 greater than 20 Mbps and upload speeds exceeding 10 Mbps.

• Workspace suitable for workstation equipment and related materials.

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

• Eligibility to work in the United States.

• Successful completion of a background check.

🏝️ Benefits

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

• Remote work arrangement.

• Work-from-home setup.