Hospital Underpayment Recovery Specialist
$37,440–$58,240 year
On-siteTennessee, United States
Job Summary
Identify a minimum of 25 healthcare insurance underpayments daily via the MEDHOST Contract Management application, verifying insurance payments for accuracy and compliance with contract terms. Analyze root causes of reimbursement variances, including zero payments, denials, and billing corrections, to resolve high-dollar underpayments and increase facility reimbursements. Collaborate with facilities to send corrected claims and appeals, utilizing Contract Management Worklist reporting and navigating clearinghouse systems to facilitate prompt identification of variances. Notate variance reasons within patient accounts, contact insurance providers to collect additional reimbursement, and communicate recovery updates to clients weekly or monthly. Prioritize activities to work variances in a timely manner while maintaining the MEDHOST Quality Management System and adhering to HIPAA privacy requirements.
Required Qualifications
- 3 years or more experience in contract management or relevant hospital revenue cycle experience
- Knowledge of hospital billing and revenue cycle terminology
- Knowledge of revenue cycle processes affecting 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 required
- Knowledge of working with Electronic Health Records or related healthcare systems
- Skilled in making accurate arithmetic computations
- Ability to understand and interpret reason for underpayments, or overpayments
- Display excellent communication skills (verbal & written), good judgement, tact, initiative, and resourcefulness
- Must be detail oriented, organized, and ability to multi-task
- Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives
- Demonstrate the ability to build and maintain strong internal and external relationships
- Utilize critical thinking skills to resolve aged and problematic accounts
- Must be flexible with a can do attitude and can remain professional under high pressure situations
- Retain and protect confidential material
- Sufficient computer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned
- Customer Service oriented
- High Speed Internet access (minimum 300 Mbps download speed) and unlimited data
- Smart phone for Multi Factor Authentication (MFA) application
Desired Qualifications
- MEDHOST (HMS) Contract Management experience is a plus
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