PFS Underpayment Support

Stanford Medicine Children's Health•Menlo Park, CA

1d•$38 - $47•Remote

About The Position

An underpayment specialist identifies and follows up on underpaid insurance accounts to secure payment. The role reviews referred accounts and reimbursement variance reports, requests additional payments, submits adjustments and appeals, and maintains accurate account information and documentation. The specialist uses available tools and resources to resolve accounts efficiently, follows assigned work lists, escalates delayed or unresolved requests, and collaborates with supervisors and other personnel to address payer contract violations and inappropriate denials. The position also produces monthly summaries and denial logs and is expected to follow up on 50 accounts per day.

Requirements

High school diploma or GED equivalent.
Two to five years of progressively responsible, directly related work experience in a healthcare setting.
Ability to follow oral and written instructions and accurately interpret institutional and other policies.
Ability to gather, analyze, and display data in an appropriate format and maintain accurate records.
Ability to maintain confidentiality of sensitive information.
Basic mathematics skills.
Ability to plan, prioritize, and meet deadlines.
Ability to work effectively with individuals at all levels of the organization.
Knowledge of insurance and medical terminology.
Knowledge of accounts receivable systems such as SMS, IDX, Meditech, or Cerner.
Knowledge of computer systems and software used in the functional area.
Knowledge of medical reimbursement policies and procedures.
Knowledge of one or more of Medicare, Medi-Cal, Workers' Compensation, or managed care (HMO, PPO, POS, etc.).
Knowledge of customer service principles and telephone courtesy.

Responsibilities

Review referred accounts to validate underpayments and analyze expected reimbursement variance reports to identify underpayments on closed carriers.
Submit adjustment requests to correct account balances affected by incorrectly applied contractual adjustments.
Enter appropriate information into Interpoint and assign collector codes to identify underpaid accounts.
Request additional payment from insurance companies using appropriate formats and documentation.
Conduct timely follow-up on assigned accounts using electronic transactions, the Internet, phone calls, and other available resources.
Escalate unresolved or unreasonably delayed reconsideration requests to an insurance company supervisor.
Review assigned Interpoint work lists and ensure appropriate, timely actions are completed.
Review and respond to mail, correspondence, and reports daily.
Review daily payment reports, identify additional payments on outstanding underpaid accounts, and update collector codes and balances when underpayments are resolved.
When accessing an account, review and correct discrepancies and update demographics, financial class, insurance, billing information, and other fields to maintain data integrity in Meditech and Cerner.
Identify payers with a history of contract violations and collaborate with a supervisor on recovery and future-compliance projects.
Produce monthly summaries of identified underpayments and recovered payments.
Evaluate denials to determine whether appeals are warranted and submit non-clinical denial appeals using appropriate formats and documentation.
Coordinate clinical appeals with case management and other appropriate personnel and ensure timely filing.
Submit denial adjustments for amounts unlikely to be paid on appeal when they cannot be billed to a subsequent payor.
Escalate unresolved or unreasonably delayed appeals to an insurance company manager.
Prepare monthly denial logs.
Identify payers with a history of inappropriate denials and collaborate with a manager on projects to prevent future denials.
Follow up on 50 accounts per day, with follow-up defined as activity that creates account resolution.
Comply with hospital policies and procedures, Service Standards, Code of Conduct, and applicable Joint Commission requirements.