Revenue Cycle Underpay Analyst

🔥 16 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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Gastro Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Secondary Market on 2021-05

Healthcare • Healthcare Insurance

Gastro Health is a healthcare provider specializing in gastroenterology, offering a wide range of services including colonoscopy, endoscopic ultrasound, and flexible sigmoidoscopy. They have multiple care centers such as surgery centers, infusion centers, and specialty pharmacies. They provide treatments for conditions like heartburn, Crohn's disease, and ulcerative colitis, along with specialty services like colorectal surgery and endoscopic weight loss. Additionally, they offer telehealth services and nutrition therapy, focusing on both adult and pediatric care.

📋 Description

• Review paid claims to identify reimbursement discrepancies and underpayments • Analyze payer reimbursements against contract terms, fee schedules, and reimbursement methodologies • Calculate expected reimbursement amounts and quantify variances • Initiate and track underpayment recovery through appeals, reconsiderations, and payer escalations • Document findings, recovery actions, and outcomes • Interpret managed care contracts, payer fee schedules, and reimbursement policies • Monitor payer compliance with contractual obligations • Identify systemic reimbursement issues and recommend corrective actions • Collaborate with Contracting teams on recurring payer payment discrepancies • Develop and maintain underpayment tracking reports and dashboards • Analyze reimbursement trends and identify revenue recovery opportunities • Quantify financial impact of payer underpayments and present findings to leadership • Prepare monthly and quarterly recovery reports • Partner with AR, Coding, HIM, Credentialing, and Contracting teams to resolve reimbursement issues • Support payer meetings with underpayment analysis and documentation • Assist with root cause analysis for denials, payment variances, and payer processing errors • Participate in revenue integrity initiatives to optimize reimbursement • Ensure recovery activities comply with payer requirements, contracts, and regulations • Maintain confidentiality of patient and financial information under HIPAA • Stay current on reimbursement methodologies, payer policies, and industry best practices

🎯 Requirements

• Minimum of 3 years of experience as a Business Analyst in healthcare settings • Experience with a large, growing healthcare organization • Ability to manage multiple priorities and meet deadlines • Strong attention to detail and accuracy • Ability to present financial findings to operational and executive leadership • Strong analytical and critical thinking skills • Ability to interpret complex payer contracts and reimbursement methodologies • Excellent written and verbal communication skills • Strong organizational and project management abilities • Ability to comply with HIPAA confidentiality requirements and applicable regulatory guidelines

🏖️ Benefits

• Consistent hours • No weekends or evenings — Monday thru Friday • Paid holidays • Paid time off • Work/life balance • Opportunities for advancement • Competitive compensation • Medical insurance • Dental insurance • Vision insurance • Spending accounts • Life / AD&D insurance • Disability insurance • Accident insurance • Critical illness insurance • Hospital indemnity insurance • Legal benefits • Identity theft protection • Pet benefits • 401(k) retirement plan with Non-Elective Safe Harbor employer contribution for eligible employees • Discretionary profit-sharing with employer contributions of 0%–4% for eligible employees • Tickets at Work discounts on concerts, travel, movies, and more