Responsible for the timely and accurate review, identification, and resolution of underpaid hospital claims.
Conduct detailed analyses of claim-level payments, follow up with payers, and prepare appeals to address single-instance and systemic underpayments.
Evaluate claim payment variances against expected reimbursements based on client-specific contract terms.
Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies.
Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial).

Experience in healthcare revenue cycle with a strong focus on underpayment/zero balance review and payer reimbursement analysis.
Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem).
Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech).
Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes.
Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules.
Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies.
Excellent written and verbal communication skills.
Proficient in Microsoft Excel and other data analysis/reporting tools.

Underpayment Recovery Analyst

Key skills