Underpayments Analyst

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Summary The Underpayment Analyst is responsible for identifying, analyzing, and recovering payer underpayments for physician professional services. This position evaluates reimbursement against payer contracts, fee schedules, regulatory requirements, and reimbursement methodologies to ensure accurate payment and contract compliance. The analyst partners with Patient Accounts, Coding, Contracting, Finance, and Operational leaders to identify revenue leakage, pursue recovery opportunities, monitor payer performance, and support revenue integrity initiatives.

Responsibilities Underpayment Analysis & Recovery Review reimbursement activity to identify underpaid physician claims and payment variances. Analyze reimbursement against payer contracts, fee schedules, and payment methodologies. Investigate and quantify underpayments related to coding edits, modifiers, multiple procedure reductions, bundling rules, place-of-service differentials, and other reimbursement methodologies.

Prepare and submit payer disputes, appeals, and reconsideration requests. Track recovery efforts and maintain documentation supporting findings and outcomes. Monitor and report underpayment recoveries and reimbursement opportunities.

Contract Compliance & Payment Validation Monitor payer adherence to negotiated reimbursement terms and contractual provisions. Utilize contract management and reimbursement analysis tools to validate claim payments and identify variances. Identify patterns of payer non-compliance and recommend corrective action.

Collaborate with Contracting, Revenue Integrity, and Information Technology teams to maintain accurate contract configuration and payment modeling. Reporting & Revenue Integrity Analyze reimbursement trends, payer performance, and recovery metrics. Prepare reports and dashboards that support reimbursement optimization and revenue cycle performance.

Identify root causes of reimbursement discrepancies and recommend process improvements. Present findings and recovery opportunities to leadership and operational stakeholders. Operational Support & Process Improvement Partner with Coding, Billing, Denials, and Contracting teams to resolve reimbursement issues.

Support initiatives that improve reimbursement accuracy, clean claim performance, and payer compliance. Develop and maintain procedures related to underpayment identification and recovery activities. Recommend workflow improvements and automation opportunities that enhance recovery efforts and reduce revenue leakage.

Qualifications Required: Associate degree in Business, Finance, Healthcare Administration, Health Information Management, or related field; or equivalent combination of education and experience Three (3) years of experience in physician revenue cycle operations, payer reimbursement analysis, revenue integrity, denials management, or related healthcare financial functions. Experience interpreting payer contracts, physician fee schedules, and reimbursement methodologies.

Experience working with Medicare, Medicaid, and commercial payer reimbursement models. undefined Preferred: Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field. Experience with contract management and reimbursement variance software. Experience performing underpayment recovery or payment variance analysis.

Experience in a multi-specialty physician practice or integrated healthcare system. Certified Professional Coder (CPC) Certified Coding Specialist (CCS) Certified Revenue Cycle Representative (CRCR) Certified Revenue Integrity Professional (CRIP) Our Cultural Beliefs People First Integrity Matters Better Together At LMH Health, we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.