[Hiring] Underpayment Analyst @Revecore

Role Description

As an Underpayment Analyst within our Revenue Integrity team, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. Your role involves examining hospital claims to verify proper reimbursement and work with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies. Strong analytical skills, attention to detail, and problem-solving skills are essential in this role.

Training:

Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences.

Responsibilities:

• Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers.
• Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
• Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client.
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting.
• Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
• Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
• Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities.
• Other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Investigative and problem-solving skills to identify underpayments and discrepancies.
• Knowledge of healthcare billing, coding, and reimbursement methodologies.
• Strong analytical abilities to dissect complex guidelines and understand their implications on claims reimbursement.
• Ability to navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines.
• Detail-oriented approach to ensure accuracy in applying guidelines and documenting findings for audit and compliance purposes.
• Effective communication skills to collaborate with internal teams, payers, and external stakeholders.
• Experience with healthcare billing software and databases (EPIC, Cerner, Meditech).
• Familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.
• Moderate computer proficiency including MS Excel, Word, and Outlook.
• Possess technical proficiency to work on multiple computer screens and software applications simultaneously.
• Previous experience working in a remote environment.

Requirements

• A quiet, distraction-free environment to work from in your home.
• A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required.
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.
• Must reside in the United States within one of the states listed below:
• Alabama
• Arkansas
• Connecticut
• Florida
• Georgia
• Iowa
• Indiana
• Kansas
• Kentucky
• Louisiana
• Massachusetts
• Maine
• Michigan
• Minnesota
• Missouri
• Mississippi
• North Carolina
• Nebraska
• New Hampshire
• Ohio
• Oklahoma
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota (CST Time Zone)
• Tennessee
• Texas (CST Time Zone)
• Vermont
• Virginia
• Wisconsin
• West Virginia

Benefits

• Revecore is an Affirmative Action/Equal Opportunity Employer committed to providing equal employment opportunities for all applicants and employees.
• We make employment decisions without regard to any characteristic protected by applicable law and encourage individuals of all backgrounds to apply.
• Employment is contingent upon eligibility to work in the United States, verification of employment history, and successful completion of a background check.