Variance Underpayment Analyst

Job Description:

• Examine hospital claims to verify proper reimbursement
• Identify discrepancies between expected and actual insurance-carrier reimbursement using company best practices, technology-enabled worklists, and internal tools
• Investigate payment variances, coding errors, billing discrepancies, and incorrect payer-policy application
• Contact insurance companies to obtain missing information, explain and resolve underpayments, and arrange payment or adjustment processing for clients
• Prepare and submit letters, emails, faxes, online inquiries, appeals, adjustments, reports, and payment postings
• Maintain documentation of underpayment root causes, trends, outcomes, and lessons learned
• Participate in discussions, meetings, and brainstorming sessions to improve processes
• Uphold ethical standards and comply with relevant regulations and organizational policies
• Perform other duties as assigned

Requirements:

• High school diploma or equivalent required
• Investigative and problem-solving skills to identify underpayments and discrepancies
• Knowledge of healthcare billing, coding, and reimbursement methodologies
• Strong analytical abilities to interpret complex guidelines and their implications for claims reimbursement
• Ability to navigate and interpret Medicare, Medicaid, and Commercial insurance guidelines
• Detail-oriented approach for accurate guideline application and documentation
• Effective communication skills for collaboration with internal teams, payers, and external stakeholders
• Experience with healthcare billing software and databases, including EPIC, Cerner, and Meditech
• Familiarity with HIPAA, CMS regulations, and state-specific healthcare reimbursement requirements
• Moderate proficiency with MS Excel, Word, and Outlook
• Ability to work across multiple computer screens and software applications simultaneously
• Previous experience working in a remote environment
• Quiet, distraction-free home workspace
• Secure home internet connection exceeding 20 Mbps download and 10 Mbps upload speeds
• Workspace accommodating workstation equipment and related materials
• Must reside in the United States within an eligible listed state
• Employment eligibility in the United States
• Successful background check

Benefits:

• Comprehensive 90-business-day training beginning on the first day
• Remote work arrangement
• Work-from-home setup
• Equal employment opportunity workplace