Hospital Underpayment Recovery Specialist

What your impact will be:

PRIMARY DUTIES AND RESPONSIBILITIES (OTHER DUTIES MAY BE ASSIGNED)

• Identify a minimum of 25 healthcare insurance underpayments for hospitals’ patient accounts per day via MEDHOST Contract Management application; identification of variance underpayments will include zero payments, full denials, line-item denials, billing corrections, updated billing code requirements and incorrect payor system setup. MEDHOST Variance & Denial Reports are utilized to assist with identification of variances.   

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

• Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve payment variances; work efforts are to be focused on identification and recovery of high dollar insurance underpayments, zero payments and trending to increase reimbursements for the hospital.  

• Utilize Contract Management Worklist reporting to facilitate prompt 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 and customer’s clearinghouse systems to identify root causes of variances.   

• Notate variance reason within patient accounts and update patient accounts utilizing pre-defined variance reason codes via MEDHOST system.     

• Contact insurance providers regarding identified underpayments and follow insurance payor guidelines to collect additional reimbursement on behalf of the facility.  

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

• Work accounts with variances utilizing a 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.  

• Notate follow-up efforts made towards the collection process on the patient accounts via MEDHOST system.  

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