Underpayment Analyst

Job Summary

Working remotely in a full-time capacity, the Underpayment Analyst will examine hospital claims to ensure accurate reimbursement, investigate discrepancies, and collaborate with stakeholders to optimize reimbursement processes while adhering to regulatory guidelines.

Key responsibilities

• Utilize internal tools to identify discrepancies between expected and actual reimbursement amounts from insurance carriers
• Investigate reasons for payment variances and contact insurance companies to resolve underpayments
• Maintain thorough documentation of underpayment issues, trends, and outcomes to support ongoing improvement efforts

Required qualifications

• High school diploma or equivalent required
• Knowledge of healthcare billing, coding, and reimbursement methodologies
• Strong analytical abilities to interpret complex guidelines affecting claims reimbursement
• Experience with healthcare billing software and databases such as EPIC, Cerner, or Meditech
• Familiarity with legal and regulatory frameworks governing healthcare reimbursement, including HIPAA and CMS regulations