Underpayment Recovery Analyst

Summit Orthopedics•Woodbury, MN

8d•Onsite

About The Position

At Summit Orthopedics, we recognize the impact each member of the Summit Family has on one another and on our patients every day. Join a patient-first environment where our values — B etter together, O wn it, N imble, E xcellence, and S ervice — are lived down to our BONES. At Summit, team members feel respected, valued, and connected to meaningful work, contributing to a collaborative, community-centered culture built on mutual respect and enjoyment. The Underpayment Recovery Analyst is responsible for capturing lost revenue due to underpayments as well as serving as a contract resource to other Summit teams needing assistance or escalation of issues. This is a full time position based at our Corporate Office located in Woodbury, MN. Monday - Friday schedule; Standard business hours (schedule subject to change).

Requirements

Use contract management system to audit, track and quantify variances between actual and expected insurance payments for facility and professional claims.
Maintain productive working relationships with provider relations contacts at the payers and submit effective appeals for underpaid accounts and follow-up timely until resolved.
Share trending payer payment issues, root causes, billing optimization and contract term improvement considerations with management in order to increase overall performance.
Conduct ongoing payer monitoring, including review of payer newsletters, provider manuals, bulletins and regulatory communication, and communicate operational impacts and required follow-up to stakeholders.
Partner with revenue cycle, business office, business analytics, credentialing, and operational leaders, as well as payer representatives, to resolve contract related issues.
Serve as a resource to Summit for contract interpretation as well as claims that need to be escalated.
Performs Ambulatory Surgery Center (ASC) case costing, profitability analysis and special requests, providing recommendations for cases to be performed in-house or scheduled at a hospital.

Responsibilities

Use contract management system to audit, track and quantify variances between actual and expected insurance payments for facility and professional claims.
Maintain productive working relationships with provider relations contacts at the payers and submit effective appeals for underpaid accounts and follow-up timely until resolved.
Share trending payer payment issues, root causes, billing optimization and contract term improvement considerations with management in order to increase overall performance.
Conduct ongoing payer monitoring, including review of payer newsletters, provider manuals, bulletins and regulatory communication, and communicate operational impacts and required follow-up to stakeholders.
Partner with revenue cycle, business office, business analytics, credentialing, and operational leaders, as well as payer representatives, to resolve contract related issues.
Serve as a resource to Summit for contract interpretation as well as claims that need to be escalated.
Performs Ambulatory Surgery Center (ASC) case costing, profitability analysis and special requests, providing recommendations for cases to be performed in-house or scheduled at a hospital.
Other duties as assigned.