Underpayments Analyst

LMH Health•Lawrence, KS

21d

About The Position

The Underpayment Analyst identifies, analyzes, and recovers payer underpayments for physician professional services. The role evaluates reimbursement against payer contracts, fee schedules, regulatory requirements, and reimbursement methodologies to ensure accurate payment and contract compliance. Working with Patient Accounts, Coding, Contracting, Finance, and operational leaders, the analyst identifies revenue leakage, pursues recovery opportunities, monitors payer performance, and supports revenue integrity initiatives.

Requirements

Associate degree in Business, Finance, Healthcare Administration, Health Information Management, or a related field; or an equivalent combination of education and experience.
Three years of experience in physician revenue cycle operations, payer reimbursement analysis, revenue integrity, denials management, or related healthcare financial functions.
Experience interpreting payer contracts, physician fee schedules, and reimbursement methodologies.
Experience working with Medicare, Medicaid, and commercial payer reimbursement models.

Nice To Haves

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field.
Experience with contract management and reimbursement variance software.
Experience performing underpayment recovery or payment variance analysis.
Experience in a multi-specialty physician practice or integrated healthcare system.
Certified Professional Coder (CPC).
Certified Coding Specialist (CCS).
Certified Revenue Cycle Representative (CRCR).
Certified Revenue Integrity Professional (CRIP).

Responsibilities

Review reimbursement activity to identify underpaid physician claims and payment variances.
Analyze reimbursement against payer contracts, fee schedules, and payment methodologies.
Investigate and quantify underpayments related to coding edits, modifiers, multiple procedure reductions, bundling rules, place-of-service differentials, and other reimbursement methodologies.
Prepare and submit payer disputes, appeals, and reconsideration requests.
Track recovery efforts and maintain documentation supporting findings and outcomes.
Monitor and report underpayment recoveries and reimbursement opportunities.
Monitor payer adherence to negotiated reimbursement terms and contractual provisions.
Use contract management and reimbursement analysis tools to validate claim payments and identify variances.
Identify patterns of payer non-compliance and recommend corrective action.
Collaborate with Contracting, Revenue Integrity, and Information Technology teams to maintain accurate contract configuration and payment modeling.
Analyze reimbursement trends, payer performance, and recovery metrics.
Prepare reports and dashboards supporting reimbursement optimization and revenue cycle performance.
Identify root causes of reimbursement discrepancies and recommend process improvements.
Present findings and recovery opportunities to leadership and operational stakeholders.
Partner with Coding, Billing, Denials, and Contracting teams to resolve reimbursement issues.
Support initiatives that improve reimbursement accuracy, clean claim performance, and payer compliance.
Develop and maintain procedures related to underpayment identification and recovery activities.
Recommend workflow improvements and automation opportunities that enhance recovery efforts and reduce revenue leakage.