[Hiring] Underpayment Specialist @Stanford Medicine Children's Health

Role Description

This paragraph summarizes the general nature, level and purpose of the job. An underpayment specialist identifies and performs follow-up to secure payment on underpaid insurance accounts.

Essential Functions

• Review referred accounts to validate an underpayment exists.
• Analyze expected reimbursement variance reports to identify underpayments on closed carriers.
• Submit adjustment requests as needed to correct account balances due to incorrectly applied contractual adjustments.
• Input appropriate information into Interpoint, and assign identifying collector code to distinguish underpaid accounts.
• Using appropriate format and documentation, request additional payment from insurance company.
• Perform timely and appropriate follow-up on all assigned accounts.
• Utilize all available tools and resources to perform follow-up in the most efficient manner; electronic transactions, Internet, phone calls, etc.
• Escalate unresolved or unreasonably delayed reconsideration requests to insurance company supervisor for special handling.
• Review assigned Interpoint work lists to ensure appropriate and timely actions are completed.
• Review and respond to mail, correspondence and reports on a daily basis.
• Review daily payment reports to identify additional payments on outstanding underpaid accounts. Input appropriate collector code to recognize the underpayment has been resolved and adjust balance accordingly.
• Every time an account is accessed, review and correct all account discrepancies, update demographics and other field values such as financial class, insurance and billing information, etc., to ensure data integrity in Meditech and Cerner.
• Identify payers with a history of contract violations and collaborate with supervisor to initiate projects to recover underpayments and facilitate future compliance with contract terms.
• Produce monthly summary of total identified underpayments and recovered payments.
• Evaluate denials to determine if appeals are warranted using appropriate format and documentation, submit non-clinical denial appeals to insurance companies.
• Coordinate clinical appeals with case management and other appropriate personnel, and ensure timely filling.
• Submit denial adjustments on denied amounts not likely to be paid on appeal, if not billable to a subsequent payor.
• Perform timely and appropriate follow-up on all assigned accounts.
• Utilize all available tools and resources to perform follow-up in the most efficient manner (electronic transactions, Internet, phone calls, etc.)
• Escalate unresolved or unreasonably delayed appeals to insurance company manager for special handling.
• Prepare monthly denial logs.
• Review assigned Interpoint work lists to ensure appropriate and timely actions are completed.
• Identify payers with a history of inappropriate denials and collaborate with manager to initiate projects to prevent future denials.
• Follow-up on 50 accounts per day. Follow-up is defined as activity performed that creates account resolution.

Qualifications

• High School diploma or GED equivalent.
• Two (2) to five (5) years of progressively responsible and directly related work experience in a healthcare setting.
• None required for license/certification.

Knowledge

• Ability to follow oral and written instructions and interpret institutional and other policies accurately.
• Ability to gather, analyze, and display data in appropriate format and keep accurate records.
• Ability to maintain confidentiality of sensitive information.
• Ability to perform basic mathematics.
• Ability to plan, prioritize and meet deadlines.
• Ability to work effectively with individuals at all levels of the organization.
• Knowledge of insurance and medical terminology.
• Knowledge of accounts receivable system like SMS, IDX, or Meditech, Cerner.
• Knowledge of computer systems and software used in functional area.
• Knowledge of medical reimbursement policies and procedures.
• Knowledge of one or more of the following: Medicare, Medi-Cal, Worker's Comp or Managed Care (HMO,PPO,POS, etc).
• Knowledge of principles and practices of customer service and telephone courtesy.

Physical Requirements

The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.

Benefits

• Compensation is based on the level and requirements of the role.
• Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data.
• Typically, new team members join at the minimum to mid salary range.
• Minimum to Midpoint Range (Hourly): $37.55 to $46.94