Underpayment Recovery Specialist - Contract Admin

Overview

Job Summary

Completes timely and accurate determination of contracted payor underpayments. Submits timely requests for reprocessing and follow-up of underpaid claims for contracted payors. Provides detail regarding the root cause of underpayments and offers actionable recommendations where appropriate to eliminate future underpayments. .

Essential Functions

• Researches and analyzes issues related to underpayments by contracted payors.
• Trends underpaid scenarios and coordinates collections with payors and internal stakeholders making recommendations for potential solutions, resulting in continuous quality improvement. Collects underpaid accounts by various methods, but not limited to the following: emails, phone calls, and meetings with payors.
• Develops relationship with payors to ensure open communication regarding issues arising from underpayments.
• Maintains expert knowledge of contracts and their reimbursement methodologies.
• Provides feedback to contract loading specialists regarding inaccurate contract build.
• Provides underpayment collections training or assistance as needed to peers.
• Meets and/or exceeds quality, productivity, and collection standards.
• Makes presentation to groups of individuals of up to 15 people.

Physical Requirements
Work requires sitting, walking, and lifting throughout the day. Must be able to lift up to 10 lbs.

Education, Experience and Certifications

High School Diploma or GED required; Bachelor's Degree preferred. Experience with Microsoft Office, Claims Processing at an insurance or managed care organization required. Patient accountant experience preferred. Understands DRG, AP-DRG, ICD9, HCPC and CPT. Excellent oral and written communication skills.