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Underpayment Analyst

Underpayment Analyst

Hudson Regional HospitalClifton, NJ, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description

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.
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    Analyst • Clifton, NJ, US