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Underpayments Analyst (Remote, US)

Job ID R25002

Location

Hackensack, New Jersey, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, Oregon, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Oklahoma, Alabama, Arizona, Arkansas, California, Connecticut, Washington, DC, Delaware, Florida, Georgia, Idaho, Illinois, New Mexico, New York, North Carolina, North Dakota, Ohio Hackensack, New Jersey, United States of America; VIRTUAL, Pennsylvania, United States of America; VIRTUAL, Rhode Island, United States of America; VIRTUAL, South Carolina, United States of America; VIRTUAL, South Dakota, United States of America; VIRTUAL, Tennessee, United States of America; VIRTUAL, Texas, United States of America; VIRTUAL, Utah, United States of America; VIRTUAL, Vermont, United States of America; VIRTUAL, Virginia, United States of America; VIRTUAL, Washington, United States of America; VIRTUAL, West Virginia, United States of America; VIRTUAL, Wisconsin, United States of America; VIRTUAL, Wyoming, United States of America; VIRTUAL, Massachusetts, United States of America; VIRTUAL, Michigan, United States of America; VIRTUAL, Minnesota, United States of America; VIRTUAL, Mississippi, United States of America; VIRTUAL, Missouri, United States of America; VIRTUAL, Montana, United States of America; VIRTUAL, Nebraska, United States of America; VIRTUAL, Nevada, United States of America; VIRTUAL, New Hampshire, United States of America; VIRTUAL, Oregon, United States of America; VIRTUAL, Indiana, United States of America; VIRTUAL, Iowa, United States of America; VIRTUAL, Kansas, United States of America; VIRTUAL, Kentucky, United States of America; VIRTUAL, Louisiana, United States of America; VIRTUAL, Maine, United States of America; VIRTUAL, Maryland, United States of America; VIRTUAL, Oklahoma, United States of America; VIRTUAL, Alabama, United States of America; VIRTUAL, Arizona, United States of America; VIRTUAL, Arkansas, United States of America; VIRTUAL, California, United States of America; VIRTUAL, Connecticut, United States of America; VIRTUAL, District of Columbia, United States of America; VIRTUAL, Delaware, United States of America; VIRTUAL, Florida, United States of America; VIRTUAL, Georgia, United States of America; VIRTUAL, Idaho, United States of America; VIRTUAL, Illinois, United States of America; VIRTUAL, New Mexico, United States of America; VIRTUAL, New York, United States of America; VIRTUAL, North Carolina, United States of America; VIRTUAL, North Dakota, United States of America; VIRTUAL, Ohio, United States of America

Date posted 03/02/2022

Applicant Data Privacy And Protection Notice

Underpayments Analyst

Overview of Position

The Hospital Billing Advocate will validate pursuable underpayment variances. 

What will be my duties and responsibilities in this job?

  • Identify variances as a result of both contractual insurance underpayments and denials.

  • Analyze multiple Client/Payer Contracts (Commercial, Managed Medicare/Medicaid, straight Governmental, Workers Comp.).

  • Analyze all Payer Policies.

  • Validate accuracy of all payer contracts including language, rates, and other specialties are loaded and are being priced accurately.

  • Pull extensive data reports to mine for contractual underpayments.

  • Evaluating entire inventory of zero balance accounts for trending underpayments.

  • Manually calculate claim allowable if applicable.

  • Validate identified claim/trend variance is accurate and pursuable.

  • Cross reference claims against fee schedules, contracted rates, language, payer policies, timeframes etc. in order to validate if a claim is contractually underpaid.

  • Call insurance carrier to gather and compare pricing information, not limited to EOBs, contracts, payer policies, patient benefits, etc. 

  • Initiate the primary reconsideration/appeal to a payer.

  • Write and submit appeals.

  • Verbally appeal via phone calls to a payer.

  • Analyze patient Medical Records for medically necessary services.

  • Review paid/unpaid claims for billing and/or coding issues for resubmission.

  • Responsible for identifying false variance not systematically closed by the respective contract modeling system and communicate findings back to leadership for modeling corrections or mass closures.

  • Communicating with leadership throughout the validation process.

  • Successful finds, challenges, prioritizing strategies, enhancements, etc.

  • Meet department and client value-based expectations.

  • Value of accounts identified to be pursued and overturned.

What are the requirements needed for this position?

  • 1-3 years of related experience within a hospital or health insurance company in: provider relations, contract management, configuration, or other related health care revenue cycle functions.

  • A high school diploma or GED. An Associates degree is preferred, with a focus in health care administration, business, finance, or a related field from an accredited college or university.

What other skills/experience would be helpful to have?

  • Proficient skills interpreting Hospital contracts that includes rates, amendments, terminology with a strong comprehension of limitations, and the insurance industry process and procedures.

  • Knowledge of workers compensation regulations and reimbursement methodology.

  • Strong decision making and problem-solving skills.

  • Familiarity with the CPT-4, ICD-9/10, and MS-DRG/APR-DRG and UB-04 claim form.

  • Analytical and/or calculation skills.

  • Knowledge of accounts receivables.

  • Understanding of managed care contracts.

  • Proficiency in MS Word, Excel and PowerPoint.

  • Experience with post payment review and recovery.

What are the working conditions and physical requirements of this job?

  • Sitting for long periods of time

  • Prolonged use of the phone

  • Remote office

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information,  national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Applicant Data Privacy And Protection Notice

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Talent Acquisition Process

Apply

Visit our career site, create a profile, and submit your application. Make sure to observe the job description and see how your background can align to the requirements of the role.

Review

Once you apply for a job opening, the Sourcing Specialist or Talent Advisor will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.

Interview

Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.

Offer

If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.

Onboarding

Once you've electronically signed your offer, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.

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