Underpayment Analyst

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Underpayment Analyst at Revecore · LumiJobs

H1B: no

Revecore The Underpayment Analyst at Revecore examines hospital claims to verify proper reimbursement and resolves issues to optimize reimbursement processes. The role requires strong analytical skills and knowledge of healthcare billing, coding, and payer policies.

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
Education/Licensing/Certifications:
High school diploma or equivalent required
Work Experience & Skills:
Investigative and problem-solving skills to identify underpayments and discrepancies

Qualification

High school diploma or equivalentKnowledge of healthcare billing

Required

High school diploma or equivalent
Investigative and problem-solving skills
Knowledge of healthcare billing, coding, and reimbursement methodologies
Strong analytical abilities to understand claims reimbursement guidelines
Ability to navigate and interpret payer policies including Medicare, Medicaid, and Commercial insurance
Detail-oriented approach for accuracy and documentation