Underpayment Analyst

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

📋 Description

• Review hospital claims to ensure correct reimbursement.

• Detect discrepancies between anticipated and actual reimbursement amounts utilizing company best practices, technology-enabled 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, rectify underpayments, and facilitate payment or adjustment processing for 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.

• Maintain ethical standards and adhere to healthcare reimbursement regulations and organizational policies.

• Work collaboratively with stakeholders to streamline reimbursement processes.

• Undertake additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• Strong investigative and problem-solving capabilities.

• Familiarity with healthcare billing, coding, and reimbursement methodologies.

• Excellent analytical skills for deciphering complex reimbursement guidelines.

• Ability to interpret Medicare, Medicaid, and Commercial insurance payer policies.

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

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

• Experience utilizing healthcare billing software and databases such as EPIC, Cerner, and Meditech.

• Understanding of HIPAA, CMS regulations, and state-specific healthcare reimbursement requirements.

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

• Technical adeptness in using multiple computer screens and applications simultaneously.

• Prior experience in a remote working environment.

• A quiet and distraction-free home workspace.

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

• Workspace must support workstation equipment and related materials.

• Must reside in the United States in an approved state listed in the posting.

• Eligibility for employment in the United States.

• Successful verification of employment history and background check.

🏝️ Benefits

• Comprehensive health coverage.

• 401(k) matching contribution.

• Paid training sessions.

• Generous paid time off (PTO).

• Paid holidays.

• 90 business days of extensive training starting on the first day.

• Opportunities for learning and development.

• Internal opportunities for career advancement.