Hospital Underpayment Recovery Specialist

Responsibilities

• Identify a minimum of 25 healthcare insurance underpayments for hospitals’ patient accounts per day via MEDHOST Contract Management application, including zero payments, full denials, line-item denials, billing corrections, updated billing code requirements, and incorrect payor system setup.
• Utilize MEDHOST Variance & Denial Reports to assist with identification of variances.
• Verify insurance payment for accuracy and compliance with contract terms and fee schedules.
• Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve payment variances, focusing on high-dollar underpayments, zero payments, and trending reimbursements.
• Use Contract Management Worklist reporting to facilitate prompt identification of insurance variances.
• Review claims billed and insurance remits to research variances, including coding, billing, and discrepancies with patients’ insurance information.
• Collaborate with facilities to send corrected claims and appeals.
• Navigate within MEDHOST and customer’s clearinghouse systems to identify root causes of variances.
• Notate variance reason within patient accounts and update using pre-defined variance reason codes via MEDHOST system.
• Contact insurance providers regarding identified underpayments and follow payor guidelines to collect additional reimbursement on behalf of the facility.
• Follow up with insurance payors once underpayment is verified and account resolution is determined based on MEDHOST standard guidelines.
• Work accounts with variances using a broad range of collection approaches, including telephone calls, conference calls, presentations, screen sharing, written communication, electronic faxing, uploading information to payor websites, and rebilling of claims.
• Notate follow-up efforts made towards the collection process on patient accounts via MEDHOST system.
• Communicate variance identification and recovery updates to clients weekly or monthly.
• Prioritize activities to work variances and denials in a timely manner.
• Collaborate with the MEDHOST Contract Management Build/Specialist team regarding contract build issues identified during underpayment research.
• Review underpayment and overpayment false variances with clients to minimize future false variances.
• Maintain customer meeting agendas and facilitate customer status calls, including variance trends, weekly/monthly variance reporting, contracts & fee schedules, and report information that may hinder Contract Management work.
• Request assistance from MEDHOST and facility leadership regarding unsuccessful attempts to collect underpayments.
• Complete projects assigned to improve operations within the team and increase reimbursements for facilities.
• Assist others with projects and provide training to team members and customers as needed.
• Collaborate with facilities and other MEDHOST teams for resolution of outstanding items.
• Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed.
• Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable.
• Perform administrative duties such as accurately inputting/submitting worked time by required deadlines, maintaining MEDHOST software applications and industry knowledge, attending training classes, and participating in team and departmental meetings.
• Respond to email, Microsoft Teams, and phone communications in a timely and professional manner.
• Ensure adherence to all HIPAA Privacy and Security requirements and responsibilities.
• Access protected health information (PHI) in accordance with departmental assignments and guidelines.
• Book travel in adherence to company and department travel policy.

Requirements

• 3+ years of experience in contract management or relevant hospital revenue cycle experience.
• MEDHOST (HMS) Contract Management experience is a plus.
• Knowledge of hospital billing and revenue cycle terminology, processes, and reimbursement, including intake, admissions, registration, billing, accounts receivable, collections, cash posting, payor logs, file maintenance, aging AR management, reporting, day-end, and month-end closing.
• Understanding of medical terminology.
• Knowledge and understanding of Explanation of Benefits (EOB), contract language, and state/federal guidelines.
• Experience working with Electronic Health Records or related healthcare systems.
• Sufficient computer skills in Microsoft Office applications (Word, Excel, PowerPoint).
• High-speed internet access (minimum 300 Mbps download speed) and unlimited data.
• Smartphone for Multi-Factor Authentication (MFA) application.

Skills

• Ability to make accurate arithmetic computations.
• Ability to understand and interpret reasons for underpayments or overpayments.
• Excellent communication skills (verbal and written), good judgment, tact, initiative, and resourcefulness.
• Detail-oriented, organized, and able to multi-task.
• Ability to build and maintain strong internal and external relationships.
• Critical thinking skills to resolve aged and problematic accounts.
• Flexible with a “can-do” attitude; able to remain professional under high-pressure situations.
• Ability to retain and protect confidential material.
• Customer service-oriented.

Pay

$18-$28 per hour