Hospital Underpayment Recovery Specialist

What your impact will be:

PRIMARY DUTIES AND RESPONSIBILITIES (OTHER DUTIES MAY BE ASSIGNED)

• Identify a minimum of 25 healthcare insurance underpayments for hospitals’ patient accounts per day via MEDHOST Contract Management application; identification of variance underpayments will include zero payments, full denials, line-item denials, 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 variances; 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 codes 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 determined 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.  

• Books travel in adherence to the company and department travel policy.  

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 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.  

What we're looking for:

Training and Experience: 

• MEDHOST (HMS) Contract Management experience is a plus.   

• 3 years or more experience in contract management or relevant hospital revenue cycle experience.  

• Follow directions and perform work according to department standards; work performed self-independently & team player.   

• Sufficient computer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned.  

• Customer Service oriented.  

Other Requirements: 

• High Speed Internet access (minimum 300 Mbps download speed) and unlimited data  

• Smart phone for Multi Factor Authentication (MFA) application