Underpayment Analyst

Revecore

11h•Remote

About The Position

As an Underpayment Analyst within our Revenue Integrity team, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. Your role involves examining hospital claims to verify proper reimbursement and work with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies. Strong analytical skills, attention to detail, and problem-solving skills are essential in this role.

Requirements

High school diploma or equivalent required
Investigative and problem-solving skills to identify underpayments and discrepancies
Knowledge of healthcare billing, coding, and reimbursement methodologies
Strong analytical abilities to dissect complex guidelines and understand their implications on claims reimbursement
Ability to navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines
Detail-oriented approach to ensure accuracy in applying guidelines and documenting findings for audit and compliance purposes
Effective communication skills to collaborate with internal teams, payers, and external stakeholders
Experience with healthcare billing software and databases (EPIC, Cerner, Meditech)
Familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.
Moderate computer proficiency including MS Excel, Word, and Outlook
Possess technical proficiency to work on multiple computer screens and software applications simultaneously
Previous experience working in a remote environment
A quiet, distraction-free environment to work from in your home.
A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required.
The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.

Responsibilities

Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers
Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies
Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization
Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes
Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities
Other duties as assigned