Underpayment Specialist

Salary Range: $34.95 - $54.87 Description

Would you like to have a career that makes a daily difference in people’s lives? Do you want to be part of a caring, respectful, diverse community? If you answered yes to these questions, keep reading!

HealthPoint is a community-based, community-supported and community-governed network of non-profit health centers dedicated to providing expert, high-quality care to all who need it, regardless of circumstances. Founded in 1971, we believe that the quality of your health care should not depend on how much money you make, what language you speak or what your health is, because everyone deserves great care.

The Contract and Underpayment Specialist is a key member of the Revenue Cycle department, responsible for analyzing and managing contracts, identifying underpayments, and ensuring timely and accurate resolution of underpayment issues. This position works closely with payer representatives, internal departments, and external stakeholders to review payer contracts and resolve discrepancies, ensuring that the organization receives appropriate reimbursement for services provided.

This role is critical in ensuring that healthcare providers receive the appropriate reimbursement for the services they provide while optimizing the overall efficiency of the revenue cycle department. The ideal candidate will possess a strong understanding of payer contracts, a keen eye for underpayment issues, and the ability to manage complex billing disputes effectively. Compensation is dependent on skills and experience.

• Analyze payer contracts and agreements to ensure reimbursement terms align with negotiated terms and regulatory guidelines.
• Interpret payer contract language and identify opportunities for revenue optimization and cost reduction.
• Maintain an in-depth understanding of payer contracts, including fee schedules, reimbursement rates, and payment structures.
• Review and monitor underpayments from insurance companies and other payers.
• Investigate and research denied or incorrectly paid claims by comparing contract terms with actual payments.
• Initiate timely appeals and resolution processes for underpaid claims, ensuring all discrepancies are documented and escalated as needed.
• Collaborate with internal billing teams to ensure proper submission of corrected claims and timely follow-ups.
• Work closely with payers and insurance companies to resolve payment discrepancies and underpayments in a timely manner.
• Serve as a point of contact for payer-related underpayment issues, communicating effectively with internal departments, including billing, coding, and legal teams.
• Collaborate with the IT department on payer contract configuration, including participation in the build and testing phases to ensure accurate reimbursement logic is implemented.
• Provide regular updates and status reports on underpayment recovery efforts to management.
• Maintain accurate records of underpayments, including tracking claim status and resolution outcomes.
• Generate reports for management detailing underpayment trends, payer performance, and recovery efforts.
• Assist in the preparation of compliance reports and audits as required.
• Maintain thorough documentation of payer contracts and reimbursement terms over time to support historical reference, contract validation, and audit readiness.
• Ensure compliance with all federal, state, and payer-specific billing, coding, and reimbursement regulations.
• Stay informed on changes in healthcare billing policies, payer regulations, and industry standards that may impact contract and payment negotiations.
• Assist in contract negotiations with new and existing payers as needed.
• Contribute to process improvement initiatives across the Revenue Cycle team.
• Maintain good attendance, is punctual and works full scheduled shift is a condition of employment.
• Demonstrate respectful, professional and appropriate behavior that supports a team-oriented work environment.
• Demonstrate a commitment to the mission, core values and goals of HealthPoint and its healthcare delivery including the ability to integrate values of justice, respect,…