Underpayment Analyst

Claims Resolution Specialist

Reviews hospital claims data to identify underpayments and pursue resolutions with third party payors.

Job Duties

• Review hospital-managed care contracts: To determine expected reimbursements and identify potential underpayments. Familiarize yourself with the rates.
• Assist with ensuring software is accurately estimating the expected payment amounts. Provide feedback to the Contract Management software team any updates or modifications needed
• Utilize Contract management software to identify contractual discrepancies and billing errors.
• Communicate with third-party payers via correspondence and phone to resolve claims and recover lost revenue.
• Work with inter-departmental customers (HIM, Registration, IT, Clinical departments) to gather necessary information and documentation to support appeals and resolutions.
• Maintain records of actions taken and resolutions achieved.
• Generate reports and queries: Use software like Microsoft Excel and Contract Management Software to analyze data and create reports.
• Provide feedback to management regarding trends and issues
• Adhere to policies and procedures related to HIPAA, FDCPA, and other applicable laws.
• Performs other duties as assigned

Qualifications and Skills

• Ability to identify trends, patterns, and discrepancies in data.
• Excellent communication skills: Ability to communicate effectively with both internal staff and external payers.
• Strong organizational skills: Ability to manage multiple tasks and prioritize work effectively.
• Proficiency in relevant software: Familiarity with claims management systems, billing software, and Microsoft Excel.
• Knowledge of healthcare industry: Understanding of coding, billing, and reimbursement processes.

Education, Experience and Certification/Licensure Requirements

• Experience with denials and underpayments: Previous experience in pursuing resolutions with third-party payers.
• High school diploma or GED required.
• Two or more years of experience: In managed care reimbursement, hospital billing, or related fields is preferred.
• Bachelor's degree: In finance, economics, business, or a related field is often preferred but not required.