Underpayment Analyst

Position Summary  

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.