Underpayment Recovery Specialist - Contract Admin

Overview

Job Summary

The Underpayment Recovery Specialist  manages various contract administration functions, including but not limited to supporting Contract Management leaders as assigned, and preparing contract-related documents and resources to support internal customers. This role will assist in maintaining the contract expected reimbursement calculations for Epic and Strata systems as assigned.

Preferred Functions

• Supports Contract Management leadership as assigned.
• Assists in the preparation of contract-related documents and resources to support internal customers.
• Analyzes, tests, and provides support for reimbursement contracts through collaboration with operational users and analyst.
• Performs regular contract audits to determine accuracy in expected reimbursements to ensure optimal performance.
• Assists in identifying and finding resolutions for payment variances discovered during audits.
• Remains up to date on current and emerging information regarding payer contracts.
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• Essential Functions
   
• Researches and analyzes issues related to underpayments by contracted payors.
• Trends underpaid scenarios and coordinates collections with payors and internal stakeholders making recommendations for potential solutions, resulting in continuous quality improvement. Collects underpaid accounts by various methods, but not limited to the following: emails, phone calls, and meetings with payors.
• Develops relationship with payors to ensure open communication regarding issues arising from underpayments.
• Maintains expert knowledge of contracts and their reimbursement methodologies.
• Provides feedback to contract loading specialists regarding inaccurate contract build.
• Provides underpayment collections training or assistance as needed to peers.
• Meets and/or exceeds quality, productivity, and collection standards.
• Makes presentation to groups of individuals of up to 15 people.

Physical Requirements
 

Work requires sitting, walking, and lifting throughout the day. Must be able to lift up to 10 lbs.

Education, Experience and Certifications
 

High School Diploma or GED required; Bachelor's Degree preferred. Experience with Microsoft Office, Claims Processing at an insurance or managed care organization required. Patient accountant experience preferred. Understands DRG, AP-DRG, ICD9, HCPC and CPT. Excellent oral and written communication skills.