Underpayment Analyst

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    "requisitionDescription": "<div><div><p id=\"isPasted\"><strong><u>Position Summary</u></strong><strong><u>&nbsp;</u></strong>&nbsp;</p><p>&nbsp;</p><p>Reviews hospital claims data to identify underpayments and pursue resolutions with third party payors.</p><p>&nbsp;</p><p><strong><u>Job Duties</u></strong></p><p><strong>&nbsp;</strong></p><ul><li>Review hospital-managed care contracts: To determine expected reimbursements and identify potential underpayments. &nbsp;Familiarize yourself with the rates. &nbsp;&nbsp;</li><li>Assist with ensuring software is accurately estimating the expected payment amounts. &nbsp; &nbsp;Provide feedback to the Contract Management software team any updates or modifications needed</li><li>Utilize Contract management software to identify contractual discrepancies and billing errors.&nbsp;</li><li>Communicate with third-party payers via correspondence and phone to resolve claims and recover lost revenue.&nbsp;</li><li>Work with inter-departmental customers (HIM, Registration, IT, Clinical departments) to gather necessary information and documentation to support appeals and resolutions.&nbsp;</li><li>Maintain records of actions taken and resolutions achieved.&nbsp;</li><li>Generate reports and queries: Use software like Microsoft Excel and Contract Management Software to analyze data and create reports.&nbsp;</li><li>Provide feedback to management regarding trends and issues</li><li>Adhere to policies and procedures related to HIPAA, FDCPA, and other applicable laws.&nbsp;</li><li>Performs other duties as assigned</li></ul><p>&nbsp;</p><p><strong><u>Qualifications and Skills</u></strong></p><p>&nbsp;</p><ul><li>Ability to identify trends, patterns, and discrepancies in data.&nbsp;</li><li>Excellent communication skills: Ability to communicate effectively with both internal staff and external payers.&nbsp;</li><li>Strong organizational skills: Ability to manage multiple tasks and prioritize work effectively.&nbsp;</li><li>Proficiency in relevant software: Familiarity with claims management systems, billing software, and Microsoft Excel.&nbsp;</li><li>Knowledge of healthcare industry: Understanding of coding, billing, and reimbursement processes.&nbsp;</li></ul><p><strong><u>&nbsp;</u></strong></p><p><strong><u>Education, Experience and Certification/Licensure Requirements</u></strong></p><p>&nbsp;</p><ul><li>Experience with denials and underpayments: Previous experience in pursuing resolutions with third-party payers.</li><li>High school diploma or GED required.</li><li>Two or more years of experience: In managed care reimbursement, hospital billing, or related fields is preferred.</li><li>Bachelor&#39;s degree: In finance, economics, business, or a related field is often preferred but not required.</li></ul></div></div>\n",
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