Underpayment Analyst

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

Ability to communicate effectively with both internal staff and external payers. Strong organizational

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

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.