Underpayment AnalystHudson Regional Hospital • Clifton, NJ, US
Underpayment Analyst
Hudson Regional Hospital • Clifton, NJ, US
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Ability to identify trends, patterns, and discrepancies in data. Excellent communication skills : Ability to communicate effectively with both internal staff and external payers. Strong organizational skills : Ability to manage multiple tasks and prioritize work effectively. Proficiency in relevant software : Familiarity with claims management systems, billing software, and Microsoft Excel. Knowledge of healthcare industry : Understanding of coding, billing, and reimbursement processes. Experience with denials and underpayments : Previous experience in pursuing resolutions with third-party payers. High school diploma or GED required. Two or more years of experience : In managed care reimbursement, hospital billing, or related fields is preferred. Bachelor's degree : In finance, economics, business, or a related field is often preferred but not required.
Position Summary
Reviews hospital claims data to identify underpayments and pursue resolutions with third party payors.
Job Duties
- Review hospital-managed care contracts : To determine expected reimbursements and identify potential underpayments. Familiarize yourself with the rates.
- Assist with ensuring software is accurately estimating the expected payment amounts. Provide feedback to the Contract Management software team any updates or modifications needed
- Utilize Contract management software to identify contractual discrepancies and billing errors.
- Communicate with third-party payers via correspondence and phone to resolve claims and recover lost revenue.
- Work with inter-departmental customers (HIM, Registration, IT, Clinical departments) to gather necessary information and documentation to support appeals and resolutions.
- Maintain records of actions taken and resolutions achieved.
- Generate reports and queries : Use software like Microsoft Excel and Contract Management Software to analyze data and create reports.
- Provide feedback to management regarding trends and issues
- Adhere to policies and procedures related to HIPAA, FDCPA, and other applicable laws.
- Performs other duties as assigned
Qualifications and Skills
Education, Experience and Certification / Licensure Requirements
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