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 payments for accuracy and compliance with contract terms. Resolve root causes of reimbursement variances, including zero payments, denials, and billing corrections, by reviewing claims, contacting insurance providers, and submitting appeals. Collaborate with facilities to send corrected claims and maintain customer meeting agendas while communicating variance trends weekly or monthly. Prioritize activities to recover high-dollar underpayments and minimize future false variances, adhering to HIPAA privacy requirements and departmental standards.
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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