Underpayment Recovery Analyst
TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.
Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.
The Underpayment Recovery Analyst is responsible for the timely and accurate review, identification, and resolution of underpaid hospital claims. This role plays a critical part in optimizing client reimbursement by conducting detailed analyses of claim-level payments, following up with payers, and preparing appeals to address single-instance and systemic underpayments. The ideal candidate brings deep expertise in hospital payer contracts, reimbursement methodologies, and denial management, and will contribute to internal performance targets and client satisfaction.
Role and Responsibilities
- CLAIMS REVIEW AND ANALYSIS
- Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
- Evaluate claim payment variances against expected reimbursements based on client-specific contract terms.
- Accurately identify and categorize underpayment types and root causes (e.g., pricing discrepancies, DRG/APC miscalculations, bundling errors, inappropriate denials).
- PAYER FOLLOW UP AND APPEALS
- Initiate rebilled or corrected claims and manage timely follow-up on outstanding underpaid or denied claims.
- Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
- Track outcomes and escalate unresolved issues as needed.
- CONTRACTUAL EXPERTISE
- Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies.
- Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial).
- ROOT CAUSE AND TREND IDENTIFICATION
- Identify and document systemic payer issues and trends affecting reimbursement.
- Partner with internal teams and client stakeholders to recommend process improvements, payer escalations, or system configuration changes.
- PERFORMANCE QUALITY
- Meet or exceed established internal Key Performance Indicators (KPIs) related to claims reviewed, identifications, recovery amounts, appeal turnaround times, and accuracy.
- Maintain up-to-date and organized case documentation in internal systems and client-facing portals.
Qualifications
- Experience in healthcare revenue cycle, with a strong focus on underpayment/zero balance review, and payer reimbursement analysis.
- Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem).
- Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech).
- Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes.
- Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules.
- Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies.
- Excellent written and verbal communication skills
- Proficient in Microsoft Excel and other data analysis/reporting tools.
Mental and physical demands
- This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and prin