Hospital Underpayment Recovery Specialist

The Hospital Underpayment Recovery Specialist is responsible for identifying healthcare insurance underpayments for hospitals, determining root cause of underpayments, engage insurance payors & hospital staff and take necessary actions to recover insurance underpayments for hospitals’ patient billing.

What your impact will be:

PRIMARY DUTIES AND RESPONSIBILITIES (OTHER DUTIES MAY BE ASSIGNED)

• Identify a minimum of 25 healthcare insurance underpayments for hospitals’ patient accounts per day via MEDHOST Contract Management application; identification of variance underpayments will include zero payments, full denials, line-item denials, billing corrections, updated billing code requirements and incorrect payor system setup. MEDHOST Variance & Denial Reports are utilized to assist with identification of variances.   

• Verify insurance payment for accuracy and compliance with contract terms and fee schedules.  

• Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve payment variances; work efforts are to be focused on identification and recovery of high dollar insurance underpayments, zero payments and trending to increase reimbursements for the hospital.  

• Utilize Contract Management Worklist reporting to facilitate prompt identification of insurance variances.  

• Review claims billed and insurance remits to research variances; claim review may include coding, billing, and discrepancies with patients’ insurance information. Collaborate with the facilities to send corrected claims and appeals. Ability to navigate within MEDHOST and customer’s clearinghouse systems to identify root causes of variances.   

• Notate variance reason within patient accounts and update patient accounts utilizing pre-defined variance reason codes via MEDHOST system.     

• Contact insurance providers regarding identified underpayments and follow insurance payor guidelines to collect additional reimbursement on behalf of the facility.  

• Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution is determined based on MEDHOST standard guidelines.   

• Work accounts with variances utilizing a broad range of collection approaches including telephone calls with individual resources, conference calls with a group of resources, presentations, screen sharing, written communication, electronic faxing, uploading information to payor websites, rebilling of claims, etc.  

• Notate follow-up efforts made towards the collection process on the patient accounts via MEDHOST system.  

• Communicate variance identification and recovery updates to clients weekly/monthly.  

• Prioritize activities to work variances and denials in a timely manner.  

• Collaborate with the MEDHOST Contract Management Build/Specialist team regarding contract build issues identified during the underpayment research process.  

• Review underpayment and overpayment false variances with client to minimize future false variances.  

• Maintain customer meeting agendas and facilitate customer status calls; communication to include variance trends identified, weekly/monthly variance reporting, contracts & fee schedules needed to maintain facility’s contract builds and report information that may hinder Contract Management work.  

• Request assistance from MEDHOST and facility’s’ leadership regarding unsuccessful attempts to collect underpayments.  

• Complete projects assigned to improve operations within the team and to increase reimbursements for facilities.  

• Assist others with projects and provide training to team members and customers as needed.  

• Collaborate with facilities and other MEDHOST teams for resolution of outstanding items.   

• Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed. 

• Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable. 

• Any other duties as deemed necessary to provide quality service to MEDHOST customer base and CM team.  

Wage:

$18-$28/hr

Administrative Duties: 

• Accurately input/submit worked time by the required departmental deadlines.  

• Maintain MEDHOST software applications utilized & industry knowledge through self-study and by attending training classes.  

• Maintain in-depth knowledge of insurance payers and collection regulations.   

• Attend and participate in team and departmental meetings.  

• Respond to email, Microsoft Teams, and phone communications in a timely manner and with professionalism.   

• Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to.   

• Access protected health information (PHI) in accordance with departmental assignments and guidelines.  

• Books travel in adherence to the company and department travel policy.  

Knowledge, Skills and Abilities: 

• Knowledge of hospital billing and revenue cycle terminology.  

• Knowledge of revenue cycle processes affecting reimbursement, including intake, admissions, registration, billing, accounts receivable, collections, cash posting, payor logs, file maintenance, aging AR management, reporting, day-end and month-end closing.  

• Understanding of medical terminology.  

• Knowledge and understanding of Explanation of Benefits (EOB), contract language, and state/federal guidelines required. 

• Knowledge of working with Electronic Health Records or related healthcare systems. 

• Skilled in making accurate arithmetic computations.  

• Ability to understand and interpret reason for underpayments, or overpayments.  

• Display excellent communication skills (verbal & written), good judgement, tact, initiative, and resourcefulness.  

• Must be detail oriented, organized, and ability to multi-task.  

• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives.  

• Demonstrate the ability to build and maintain strong internal and external relationships.   

• Utilize critical thinking skills to resolve aged and problematic accounts.  

• Must be flexible with a “can do” attitude and can remain professional under high pressure situations.  

• Retain and protect confidential material.  

What we're looking for:

Training and Experience: 

• MEDHOST (HMS) Contract Management experience is a plus.   

• 3 years or more experience in contract management or relevant hospital revenue cycle experience.  

• Follow directions and perform work according to department standards; work performed self-independently & team player.   

• Sufficient computer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned.  

• Customer Service oriented.  

Other Requirements: 

• High Speed Internet access (minimum 300 Mbps download speed) and unlimited data  

• Smart phone for Multi Factor Authentication (MFA) application 

What we offer:

• Plenty of opportunities to grow your career
• Comprehensive medical, dental, and vision benefits
• 3 weeks of vacation plus 5 personal days to recharge
• Employee stock ownership and RRSP program
• A chance to give back through community involvement
• Flexible work arrangements to suit your lifestyle

About us:

MEDHOST, founded in 1984 and headquartered in Franklin, Tennessee, is a leading provider of healthcare information technology solutions. Serving over 1,000 healthcare facilities nationwide, MEDHOST offers a comprehensive suite of products, including electronic health records (EHR), financial management systems, and patient engagement platforms. Their mission is to empower healthcare organizations to enhance patient care and improve business operations through innovative, user-friendly solutions. In January 2024, MEDHOST was acquired by N. Harris Computer Corporation, further strengthening its position in the healthcare IT industry.

About Harris Computer:

Harris provides mission critical software solutions for the Public Sector, Healthcare, Utilities and Private Sector verticals throughout North America, Europe, Asia and Australia.

Working for Harris is the perfect opportunity to fulfill your professional goals as well as achieve your personal dreams!

Our employees enjoy a casual work environment that offers comfort while providing superior service to our customers. We offer a comprehensive benefit package as well as other additional “Perks”!

• We empower our employees to make a difference
• We have an award-winning culture
• We offer opportunity to learn
• We are financially strong and we are owned by the largest software company in Canada (CSI)
• We have fun!

Follow us on social media to learn more about our company values, culture and initiatives!

• Instagram: ⁠@weareharris
• LinkedIn: ⁠Harris Computer