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

Education, Experience and Certification / Licensure Requirements