Hospital Underpayment Recovery Specialist

Harris Computer•Arlington, TN

6d•$18 - $28•Remote

About The Position

This role focuses on identifying and recovering underpayments from healthcare insurance providers for hospital patient accounts. The specialist will utilize the MEDHOST Contract Management application and related reports to find variances, verify payments against contract terms, and resolve reimbursement issues. Key responsibilities include analyzing claims and remits, contacting insurance providers, managing collections, and communicating updates to clients. The position also involves administrative duties such as time tracking, maintaining industry knowledge, and adhering to HIPAA regulations.

Requirements

3 years or more experience in contract management or relevant hospital revenue cycle experience.
Follow directions and perform work according to department standards; work performed self-independently & team player.
Sufficient computer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned.
Customer Service oriented.
High Speed Internet access (minimum 300 Mbps download speed) and unlimited data
Smart phone for Multi Factor Authentication (MFA) application

Nice To Haves

MEDHOST (HMS) Contract Management experience is a plus.

Responsibilities

Identify a minimum of 25 healthcare insurance underpayments for hospitals’ patient accounts per day via MEDHOST Contract Management application.
Verify insurance payment for accuracy and compliance with contract terms and fee schedules.
Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve payment variances.
Utilize Contract Management Worklist reporting to facilitate prompt identification of insurance variances.
Review claims billed and insurance remits to research variances, collaborating with facilities to send corrected claims and appeals.
Notate variance reason within patient accounts and update patient accounts utilizing pre-defined variance reason codes via MEDHOST system.
Contact insurance providers regarding identified underpayments and follow insurance payor guidelines to collect additional reimbursement on behalf of the facility.
Follow-up with insurance payors once the underpayment is verified and account resolution is determined.
Work accounts with variances utilizing a broad range of collection approaches.
Notate follow-up efforts made towards the collection process on the patient accounts via MEDHOST system.
Communicate variance identification and recovery updates to clients weekly/monthly.
Prioritize activities to work variances and denials in a timely manner.
Collaborate with the MEDHOST Contract Management Build/Specialist team regarding contract build issues.
Review underpayment and overpayment false variances with client to minimize future false variances.
Maintain customer meeting agendas and facilitate customer status calls.
Request assistance from MEDHOST and facility’s’ leadership regarding unsuccessful attempts to collect underpayments.
Complete projects assigned to improve operations within the team and to increase reimbursements for facilities.
Assist others with projects and provide training to team members and customers as needed.
Collaborate with facilities and other MEDHOST teams for resolution of outstanding items.
Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements.
Accurately input/submit worked time by the required departmental deadlines.
Maintain MEDHOST software applications utilized & industry knowledge through self-study and by attending training classes.
Maintain in-depth knowledge of insurance payers and collection regulations.
Attend and participate in team and departmental meetings.
Respond to email, Microsoft Teams, and phone communications in a timely manner and with professionalism.
Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to.
Access protected health information (PHI) in accordance with departmental assignments and guidelines.
Books travel in adherence to the company and department travel policy.