Payer Underpayment Recovery Specialist

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $31 - $39 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Spire Orthopedic Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2021

🤝 B2B

🏢 Enterprise

B2B • Enterprise

Spire Orthopedic Partners is a forward-looking capital and management partner for leading orthopedic and spine surgeons, operating as a management services organization (MSO) that provides administrative infrastructure and strategic support. The company partners with high-growth orthopedic practices across the Northeastern United States (Connecticut, New York, Massachusetts, Rhode Island), enabling around 165 physicians and 1,800 employees across 40 locations to grow, specialize, and focus on patient care while Spire handles operations, practice integration, and business development.

📋 Description

• Identify potential payer underpayments by reviewing payment data, contractual allowed amounts, fee schedules, EOBs/ERAs, payer policies, claim history, and expected reimbursement calculations • Use Rivet, Modernizing Medicine, Athena, Excel, and payer portals to research reimbursement variances • Validate underpayment opportunities by comparing actual payments to contracted rates • Research payer contracts, fee schedules, reimbursement methodologies • Prepare clear and complete documentation packages to support payer reconsideration • Submit underpayment disputes, reconsideration requests, appeals, and payer inquiries within required payer timeframes • Track underpayment cases from identification through resolution • Maintain Excel-based spreadsheets and trackers to monitor underpayment opportunities • Partner with billing, coding, payment posting, payer collections, contracting, and revenue integrity teams to resolve payment discrepancies • Identify trends by payer, CPT code, modifier, provider, practice, location, system, or contract term and escalate recurring issues • Support reporting on underpayment recovery, revenue impact, payer trends, aged cases, overturn rates, and process improvement opportunities.

🎯 Requirements

• Experience in healthcare revenue cycle, payer collections, reimbursement analysis, contract variance review, payment posting, denials, or revenue integrity • Experience using Rivet, Modernizing Medicine, Athena, Excel, and spreadsheet-based trackers strongly preferred • Intermediate to advanced Excel proficiency required • Strong understanding of EOBs, ERAs, payer contracts, fee schedules, CPT/HCPCS codes, modifiers, claim forms • Ability to analyze expected versus actual reimbursement and clearly explain payment variances • Strong written communication skills • Detail-oriented with strong organizational skills • Experience with orthopedic, surgical, ASC, or specialty physician billing preferred • Knowledge of commercial, Medicare, Medicaid, workers' compensation, bundled payment, and value-based arrangements preferred • Bachelor’s degree preferred; relevant healthcare revenue cycle or reimbursement experience may be considered in lieu of a degree.

🏖️ Benefits

• Excellent growth and advancement opportunities • Dynamic environment • Access to a diverse network of practitioners • Broad infrastructure of tools and programs to enhance the employee experience • Competitive Compensation • Generous PTO • Health, dental, vision, 401(k), etc.