Senior Underpayment Analyst Work From Home in San Antonio, TX at Parallon

Date Posted: 7/15/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
    Other
  • Experience:
    Not Specified
  • Date Posted:
    7/15/2018

Job Description



Senior Underpayment Analyst

Job Summary
- Researches and Resolves High Dollar Insurance Payer Underpayments through concise understanding of Payer Contract language and respective payment calculation. Position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult high dollar underpayments. Candidate will demonstrate ability to grow strategic payer relationships and obtain understanding of payer system to navigate through claims processing centers. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the Payment Compliance Director. Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action.

Supervisor – Director, Payment Compliance

Supervises - N/A

Duties (included but not limited to):

• Analyzes hospital claims to identify contractual underpayments or billing errors.

• Resolves underpaid claims from various payer products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.

• Articulates contract provisions to representatives from healthcare payer companies and government agencies.

• Contacts payer companies via phone or correspondence and initiates request for payment.

• Performs appropriate follow up with Payer and gains commitment for payment.

• Escalates Payer lack of response and/or lack of payment within Payer organization as appropriate.

• Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.

• Identifies Payer company trends and communicates trends to supervisor for further action/escalation.

• Serves as a subject matter expert in Payer contract dispute resolution process.

• Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"

• Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES

• Communication - communicates clearly and concisely, verbally and in writing.

• Persistence – comfortable pursuing, rebutting and escalating issues as appropriate.

 

• Goal-oriented – holds him/herself accountable to achieving shared and personal goals.

• Customer orientation - establishes and maintains long-term customer relationships, building trust and

respect by consistently meeting and exceeding expectations.

• Interpersonal skills - able to work effectively with other employees, patients and external parties.

• PC skills - demonstrates high proficiency in Microsoft Office applications and others as required.

• Policies & Procedures - demonstrates knowledge and understanding of organizational policies,

procedures and systems.

• Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures

• Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.

Job Requirements

EDUCATION

• Bachelor’s degree required.

• Master’s degree preferred.

EXPERIENCE

• Two years of related experience preferred.

CERTIFICATE/LICENSE - N/A

PHYSICAL DEMANDS/WORKING CONDITIONS

Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.

OSHA CATEGORY – The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first

aid, or to be potentially exposed in some other way.

CHECK OUT OUR SIMILAR JOBS

  1. Research Analyst Jobs
  2. Operations Analyst Jobs