Underpayment Recovery Analyst

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🕒 April 1

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

💰 Private Equity Round on 2023-01

Healthcare Insurance • Fintech • Artificial Intelligence

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Responsible for the timely and accurate review, identification, and resolution of underpaid hospital claims. • Conduct detailed analyses of claim-level payments, follow up with payers, and prepare appeals to address single-instance and systemic underpayments. • Evaluate claim payment variances against expected reimbursements based on client-specific contract terms. • Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies. • Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial).

🎯 Requirements

• Experience in healthcare revenue cycle with a strong focus on underpayment/zero balance review and payer reimbursement analysis. • Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem). • Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech). • Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes. • Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules. • Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies. • Excellent written and verbal communication skills. • Proficient in Microsoft Excel and other data analysis/reporting tools.

🏖️ Benefits

• Competitive salaries • Highly valued health insurance • 401(k) plan with employer match • Paid parental leave • More