Hospital Underpayment Recovery Specialist
What your impact will be:
PRIMARY DUTIES AND RESPONSIBILITIES(OTHER DUTIES MAY BE ASSIGNED)
- Identifya minimum of 25healthcare insurance underpaymentsfor hospitals’patient accountsper dayvia MEDHOST Contract Management application;identification of varianceunderpaymentswill includezero payments, full denials, line-item denials, billing corrections, updated billing coderequirementsand incorrect payor system setup.MEDHOST Variance & Denial Reports areutilizedtoassistwith identification of variances.
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Verify insurance payment for accuracy and compliance with contract terms and fee schedules.
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Identifyroot cause of insurance reimbursement underpayments and takeappropriate actionsto resolve payment variances;work efforts are to be focusedonidentification and recovery ofhigh dollar insurance underpayments, zero paymentsand trendingto increase reimbursements for the hospital.
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Utilize Contract Management Worklist reporting tofacilitateprompt identification of insurance variances.
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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 andcustomer’sclearinghouse systems toidentifyroot causes of variances.
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Notatevariance reason within patient accounts and update patient accountsutilizingpre-defined variance reasoncodesvia MEDHOST system.
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Contactinsurance providersregardingidentified underpayments and follow insurance payor guidelines to collectadditionalreimbursement on behalf of the facility.
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Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution isdeterminedbased on MEDHOST standard guidelines.
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Work accounts with variancesutilizinga 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.
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Notatefollow-up efforts made towards the collection process on the patient accounts viaMEDHOSTsystem.
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Communicate variance identification and recovery updates to clients weekly/monthly.
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Prioritize activities to work variances and denialsin a timely manner.
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Collaborate with the MEDHOST Contract Management Build/Specialist teamregardingcontract build issuesidentifiedduring the underpaymentresearchprocess.
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Review underpayment andoverpaymentfalse variances with client to minimize future false variances.
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Maintain customer meeting agendas andfacilitatecustomer status calls; communication to include variance trendsidentified, weekly/monthlyvariancereporting, contracts & fee schedules needed tomaintainfacility’scontract builds and report information that may hinder Contract Management work.
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RequestassistancefromMEDHOST andfacility’s’leadershipregardingunsuccessful attempts to collect underpayments.
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Complete projectsassignedto improve operations within the team and to increase reimbursements for facilities.
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Assist others with projectsand provide trainingto team members and customersasneeded.
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Collaborate withfacilities andother MEDHOST teams for resolution of outstanding items.
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Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed.
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Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable.
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Any other duties asdeemednecessary to provide quality service to MEDHOST customer base and CM team.
Wage:
$18-$28/hr
Administrative Duties:
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Accurately input/submitworked time by the required departmental deadlines.
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Maintain MEDHOST software applicationsutilized& industry knowledge through self-study and by attending training classes.