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Role Description

As a Lead Underpayment Analyst within our Revenue Integrity team, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. This role is dual focused, split between examining hospital claims to verify proper reimbursement, working with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies and also supporting the team as they do the same. Strong analytical skills, attention to detail, and problem-solving skills are essential in this role.

• Provide training and onboarding support to new analysts as outlined in the Training and Development Onboarding programs.
• Provide assistance to address analysts’ technical questions and needs on claims handling, serving as a backup to the Supervisor.
• Serve as liaison between analysts and Supervisor / Director.
• Participate in the quality assurance process for the department, ensuring all applicable guidelines/deadlines are successfully achieved.
• May review and approve adjustments on claims, up to a predetermined amount.
• May provide high-level claims review of new and existing clients, while also maintaining a client workload.
• Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers.
• Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
• Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client.
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting.
• Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
• Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
• Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities.

Qualifications

• Strong performance in the Underpayment Analyst role
• Experience with mentoring/supporting others
• Experience with Month End duties
• Examples of going above and beyond in current role
• Experience with being delegated responsibilities outside of the Underpayment Analyst role
• Moderate computer proficiency including MS Excel, Word and Outlook.

Requirements

• A quiet, distraction-free environment to work from in your home.
• A secure internet connection is required.
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.
• Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check.

Benefits

• We offer paid training and incentive plans
• Our medical, dental, vision, and life insurance benefits are available from the first day of employment
• We enjoy excellent work/life balance
• Our Employee Resource Groups build community and foster a culture of belonging and inclusion
• We match 401(k) contributions
• We offer career growth opportunities
• We celebrate 12 paid holidays and generous paid time off

Company Description

Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.