Remote Contractual Claims Analyst: Reimbursement Recovery

Health Business Solutions LLC; Florida; On-site; USD 55,000 - 75,000; Part time

Job summary

Health Business Solutions (HBiz) is seeking a Contractual Claims Analyst to review and resolve complex reimbursement discrepancies across payer contracts and remittance data. You will validate contractual adjustments, perform disputes and appeals, and document recovery efforts.

The role emphasizes analyzing contract terms, reimbursement methodologies, and payment variances, with collaboration across Revenue Cycle, Contracting, and Patient Financial Services to maximize recoveries and ensure

Qualifications

• High school diploma or equivalent; associate or bachelor degree preferred.
• 2+ years in healthcare revenue cycle, reimbursement, or contract analysis preferred.
• Experience resolving underpayments or misreimbursed claims.
• Knowledge of commercial and government payer reimbursement practices.
• Ability to read and interpret payer contracts, amendments, fee schedules, and payment provisions.
• Strong analytical, research, and problem-solving skills.

Responsibilities

• Review and resolve contractual underpayments and payment variances.
• Analyze payer contracts, fee schedules, and reimbursement provisions to determine expected reimbursement.
• Calculate and compare expected vs actual reimbursement.
• Identify variances and determine recovery or adjustment actions.
• Review EOBs/ERAs for discrepancies and potential contractual issues.
• Prepare payer disputes, reconsiderations, and appeals to pursue recovery.

Skills

Analytical skills

Attention to detail

Communication skills

Contract interpretation

Education

Associate or bachelor's degree in business, healthcare administration, finance, accounting, health information management, or related field

Tools

Microsoft Excel

Job description

Health Business Solutions (HBiz) is seeking a Contractual Claims Analyst to review and resolve complex reimbursement discrepancies across payer contracts and remittance data. You will validate contractual adjustments, perform disputes and appeals, and document recovery efforts.

The role emphasizes analyzing contract terms, reimbursement methodologies, and payment variances, with collaboration across Revenue Cycle, Contracting, and Patient Financial Services to maximize recoveries and ensure