Underpayment Analyst in Nashville, TN at Parallon

Date Posted: 4/15/2018

Job Snapshot

  • Employee Type:
  • Location:
    Nashville, TN
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.

Job Summary – Researches and Resolves High Dollar Insurance Payor Underpayments through concise understanding of Payor 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 payor relationships and obtain understanding of payor system to navigate through claims processing centers. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the AVP.  Responsible for bundling similar cases not resolved through the Corporate Payment Compliance unit and escalate to Dispute Resolution Team for legal action. 

Duties (included but not limited to):

  • Analyzes hospital claims to identify contractual underpayments or billing errors.
  • Resolves underpaid claims from various Payor products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.
  • Articulates contract provisions to representatives from healthcare Payor companies and government agencies.
  • Contacts Payor companies via phone or correspondence and initiates request for payment.
  • Performs appropriate follow up with Payor and gains commitment for payment.
  • Escalates Payor lack of response and/or lack of payment within Payor organization as appropriate.
  • Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
  • Identifies Payor company trends and communicates trends to supervisor for further action/escalation.
  • Serves as a subject matter expert in Payor contract dispute resolution process.
  • Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Other duties as assigned

Job Requirements

  • High school diploma or GED required.
  • Bachelor’s degree required.
  • Master’s degree preferred.
  • Two years of related experience preferred.