Underpayment Analyst

Hudson Regional Hospital; Clifton (NJ); On-site; USD 39,000 - 45,000; Full time

Job summary

Hudson Regional Hospital in Clifton, NJ is seeking an Underpayment Analyst to review hospital claims data, identify underpayments, and pursue resolutions with third-party payors. The role involves analyzing contracts, ensuring accurate payment estimates, and communicating with payers to recover revenue.

Ideal candidates will have a background in managed care reimbursement, strong data analysis, and effective communication with internal teams and external payers.

Qualifications

• Experience with denials and underpayments in pursuing resolutions with third-party payers.
• Ability to identify trends, patterns, and discrepancies in data.
• Strong communication and organizational skills.

Responsibilities

• Review hospital-managed care contracts to determine expected reimbursements and identify potential underpayments.
• Assist with software accuracy in estimating payment amounts; provide feedback for updates.
• Use contract management software to identify discrepancies and billing errors.
• Communicate with third-party payers to resolve claims and recover revenue.
• Coordinate with HIM, Registration, IT and clinical departments to gather information for appeals.

Skills

Data analysis

Communication

Organizational skills

Education

High school diploma or GED

Bachelor's degree in finance/economics/business

Tools

Excel

Claims management software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Underpayment Analyst

Full Time Non Union Clerical Clifton, NJ, US 1 Attachments

30+ days ago Requisition ID: 3237

Salary Range: $28.00 To $33.00 Hourly

Position Summary

Reviews hospital claims data to identify underpayments and pursue resolutions with third party payors.

Job Duties

• Review hospital-managed care contracts: To determine expected reimbursements and identify potential underpayments. Familiarize yourself with the rates.
• Assist with ensuring software is accurately estimating the expected payment amounts. Provide feedback to the Contract Management software team any updates or modifications needed
• Utilize Contract management software to identify contractual discrepancies and billing errors.
• Communicate with third-party payers via correspondence and phone to resolve claims and recover lost revenue.
• Work with inter-departmental customers (HIM, Registration, IT, Clinical departments) to gather necessary information and documentation to support appeals and resolutions.
• Maintain records of actions taken and resolutions achieved.
• Generate reports and queries: Use software like Microsoft Excel and Contract Management Software to analyze data and create reports.
• Provide feedback to management regarding trends and issues
• Adhere to policies and procedures related to HIPAA, FDCPA, and other applicable laws.
• Performs other duties as assigned

Qualifications and Skills

• Ability to identify trends, patterns, and discrepancies in data.
• Excellent communication skills: Ability to communicate effectively with both internal staff and external payers.
• Strong organizational skills: Ability to manage multiple tasks and prioritize work effectively.
• Proficiency in relevant software: Familiarity with claims management systems, billing software, and Microsoft Excel.
• Knowledge of healthcare industry: Understanding of coding, billing, and reimbursement processes.

Education, Experience and Certification/Licensure Requirements

• Experience with denials and underpayments: Previous experience in pursuing resolutions with third-party payers.
• High school diploma or GED required.
• Two or more years of experience: In managed care reimbursement, hospital billing, or related fields is preferred.
• Bachelor's degree: In finance, economics, business, or a related field is often preferred but not required.