Variance Underpayment Analyst

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

📋 Description

• Review hospital claims to ensure appropriate reimbursement.

• Detect inconsistencies between anticipated and actual insurance-carrier reimbursement using industry best practices, technology-driven worklists, and internal resources.

• Investigate payment discrepancies, coding mistakes, billing errors, and incorrect application of payer policies.

• Communicate with insurance companies to gather missing information, clarify and resolve underpayments, and facilitate payment or adjustment processing for clients.

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

• Keep records of the root causes of underpayments, trends, outcomes, and insights gained.

• Engage in discussions, meetings, and brainstorming sessions aimed at process improvements.

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

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• High school diploma or an equivalent qualification is mandatory.

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

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

• Solid analytical skills to understand complex guidelines and their impact on claims reimbursement.

• Ability to navigate and interpret guidelines from Medicare, Medicaid, and Commercial insurance.

• Detail-oriented mindset for accurate application of guidelines and documentation.

• 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.

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

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

• Capability to work across multiple computer screens and software applications simultaneously.

• Previous experience in a remote work setting.

• A quiet, distraction-free home working environment.

• Secure home internet connection with speeds exceeding 20 Mbps for downloads and 10 Mbps for uploads.

• Workspace that accommodates workstation equipment and related materials.

• Must reside in the United States within a state that is eligible.

• Employment eligibility in the United States is required.

• A successful background check is necessary.

🏝️ Benefits

• Comprehensive training program spanning 90 business days starting from the first day of employment.

• Opportunity for remote work.

• Work-from-home arrangement.

• Equal employment opportunity workplace.