Hospital Underpayment Recovery Specialist

What your impact will be:

PRIMARY DUTIES AND RESPONSIBILITIES(OTHER DUTIES MAY BE ASSIGNED)

• Identifya minimum of 25healthcare insurance underpaymentsfor hospitals’patient accountsper dayvia MEDHOST Contract Management application; identification of varianceunderpaymentswill includezero payments, full denials, line-item denials, billing corrections, updated billing coderequirementsand incorrect payor system setup.MEDHOST Variance & Denial Reports areutilizedtoassistwith identification of variances.

• Verify insurance payment for accuracy and compliance with contract terms and fee schedules.

• Identifyroot cause of insurance reimbursement underpayments and takeappropriate actionsto resolve payment variances; work efforts are to be focusedonidentification and recovery ofhigh dollar insurance underpayments, zero paymentsand trendingto increase reimbursements for the hospital.

• Utilize Contract Management Worklist reporting tofacilitateprompt 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 andcustomer’sclearinghouse systems toidentifyroot causes of variances.

• Notatevariance reason within patient accounts and update patient accountsutilizingpre-defined variance reasoncodesvia MEDHOST system.

• Contactinsurance providersregardingidentified underpayments and follow insurance payor guidelines to collectadditionalreimbursement on behalf of the facility.

• Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution isdeterminedbased on MEDHOST standard guidelines.

• Work accounts with variancesutilizinga 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.

• Notatefollow-up efforts made towards the collection process on the patient accounts viaMEDHOSTsystem.

• Communicate variance identification and recovery updates to clients weekly/monthly.

• Prioritize activities to work variances and denialsin a timely manner.

• Collaborate with the MEDHOST Contract Management Build/Specialist teamregardingcontract build issuesidentifiedduring the underpaymentresearchprocess.

• Review underpayment andoverpaymentfalse variances with client to minimize future false variances.

• Maintain customer meeting agendas andfacilitatecustomer status calls; communication to include variance trendsidentified, weekly/monthlyvariancereporting, contracts & fee schedules needed tomaintainfacility’scontract builds and report information that may hinder Contract Management work.

• RequestassistancefromMEDHOST andfacility’s’leadershipregardingunsuccessful attempts to collect underpayments.

• Complete projectsassignedto improve operations within the team and to increase reimbursements for facilities.

• Assist others with projectsand provide trainingto team members and customersasneeded.

• Collaborate withfacilities andother 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 asdeemednecessary to provide quality service to MEDHOST customer base and CM team.

Wage:

$18-$28/hr

Administrative Duties:

• Accurately input/submitworked time by the required departmental deadlines.

• Maintain MEDHOST software applicationsutilized& industry knowledge through self-study and by attending training classes.

• Maintain in-depth knowledge of insurance payers and collection regulations.

• Attend andparticipatein team and departmental meetings.

• Respond to email, Microsoft Teams, and phone communicationsin a timelymannerand with professionalism.

• Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to.

• Access protected health information (PHI)in accordance withdepartmental assignments and guidelines.

• Bookstravel in adherence to the companyand departmenttravel policy.

Knowledge, Skillsand 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-endand month-end closing.

• Understanding ofmedical terminology.

• Knowledge and understanding of Explanation of Benefits (EOB), contract language, and state/federal guidelinesrequired.

• Knowledge of working with Electronic Health Records or related healthcare systems.

• Skilled in makingaccuratearithmetic 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 todemonstratesupportiverelationshipswith peers, clients, partners, andcorporateexecutives.

• Demonstrate the ability to build andmaintainstrong internaland externalrelationships.

• Utilize critical thinking skills to resolveagedand problematic accounts.

• Mustbeflexiblewitha “cando” attitudeandcanremainprofessionalunderhighpressuresituations.

• Retain and protect confidential material.

What we're looking for:

Training and Experience:

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

• 3years ormoreexperience incontract management or relevant hospitalrevenue cycleexperience.

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

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

• Customer Serviceoriented.

Other Requirements:

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

• Smart phone for Multi Factor Authentication (MFA) application