Hospital Underpayment Recovery Specialist

About this role

The Hospital Underpayment Recovery Specialist is responsible for identifying healthcare insurance underpayments for hospitals, determining root cause of underpayments, engage insurance payors & hospital staff and take necessary actions to recover insurance underpayments for hospitals’ patient billing.

What your impact will be: PRIMARY DUTIES AND RESPONSIBILITIES   (OTHER DUTIES MAY BE ASSIGNED) • Identify   a minimum of 25   healthcare insurance underpayments   for hospital s’   patient accounts   per day   via MEDHOST Contract Management application ;   identification of variance   underpayment s   will include   zero payments , full denials, line-item den ials , billing corrections, updated billing code   requirements   and incorrect payor system setup.   MEDHOST Variance & Denial Reports are   utilized   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 variance s ;   work efforts are to be focused   on   identification and recovery of   high dollar insurance underpayments , zero payments   and trending   to increase reimbursements for the hospital.   

• Utilize Contract Management Worklist reporting to   facilitate   prompt identification of insurance variances.   

• Review claims billed and insurance remits to research variances; claim review may include coding,   billing,   and discrepancies with patients’ insurance information.   Collaborate with the facilities to send corrected claims and appeals.   Ability to navigate within MEDHOST and   customer’s   clearinghouse systems to   identify   root causes of variances .    

• Notate   variance reason within patient accounts and update patient accounts   utilizing   pre-defined variance reason   code s   via MEDHOST system .         

• Contact   insurance providers   regarding   identified underpayments and follow insurance payor guidelines to collect   additional   reimbursement on behalf of the facility.   

• Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution is   determine d   based on MEDHOST standard guidelines .     

• Work accounts with variances   utilizing   a broad range of collection approaches including telephone calls with individual resources, conference calls with a group of resources,   presentations, screen sharing,   written communication,   electronic faxing, uploading information to payor websites,   rebilling of claims, etc.   

• Notate   follow-up efforts made towards the collection process on the patient accounts via   MEDHOST   system.   

• Communicate variance identification and recovery updates to clients weekly/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 the underpayment   research   process.   

• Review underpayment and   overpayment   false variances with client to minimize future false variances.   

• Maintain customer meeting agendas and   facilitate   customer status calls; communication to include variance trends   identified , weekly/monthly   variance   reporting, contracts & fee schedules needed to   maintain   facility’s   contract builds and report information that may hinder Contract Management work.   

• Request   assistance   from   MEDHOST and   facility’s’   leadership   regarding   unsuccessful attempts to collect underpayments.   

• Complete projects   assigned   to improve operations within the team and to 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.  

• Any other duties as   deemed   necessary to provide quality service to MEDHOST customer base and CM team.   

  Wage: $18-$28/hr

Administrative Duties:  

• Accurately input/ submit   worked time by the required departmental deadlines .   

• Maintain MEDHOST software applications   utilized   & industry knowledge through self-study and by attending training classes .   

• Maintain in-depth knowledge of insurance payers and collection regulations .     

• Attend and   participate   in team and departmental meetings .   

• Respond to email , Microsoft Teams,   and phone communications   in a timely   manner   and with professionalism .     

• Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to .     

• Access protected health information (PHI)   in accordance with   departmental assignments and guidelines .   

• B ooks   travel in adherence to the company   and department   travel polic y.   

What will make you stand out:

Knowledge,   Skills   and Abilities:  

• 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 ove

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