Sr. Underpayment Analyst

HCA Houston , TX 77020

Posted 4 months ago

Job Summary

  • Researches and Resolves High Dollar Insurance Payer Underpayments through concise understanding of Payer Contract language and respective payment calculation. Position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult high dollar underpayments. Candidate will demonstrate ability to grow strategic payer relationships and obtain understanding of payer system to navigate through claims processing centers. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the Payment Compliance Director. Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action. (This position is a full-time work from home opportunity).

Supervisor Director, Payment Compliance

Duties (included but not limited to):

  • Analyzes hospital claims to identify contractual underpayments or billing errors.

  • Resolves underpaid claims from various payer products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.

  • Articulates contract provisions to representatives from healthcare payer companies and government agencies.

  • Contacts payer companies via phone or correspondence and initiates request for payment.

  • Performs appropriate follow up with Payer and gains commitment for payment.

  • Escalates Payer lack of response and/or lack of payment within Payer organization as appropriate.

  • Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.

  • Identifies Payer company trends and communicates trends to supervisor for further action/escalation.

  • Serves as a subject matter expert in Payer contract dispute resolution process.

  • Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"

  • Other duties as assigned


  • Communication - communicates clearly and concisely, verbally and in writing.

  • Persistence comfortable pursuing, rebutting and escalating issues as appropriate.

  • Goal-oriented holds him/herself accountable to achieving shared and personal goals.

  • Customer orientation - establishes and maintains long-term customer relationships, building trust and

respect by consistently meeting and exceeding expectations.

  • Interpersonal skills - able to work effectively with other employees, patients and external parties.

  • PC skills - demonstrates high proficiency in Microsoft Office applications and others as required.

  • Policies & Procedures - demonstrates knowledge and understanding of organizational policies,

procedures and systems.

  • Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures

  • Writing skills advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.


  • Bachelor's degree required.

  • Master's degree preferred.


  • Two years of related experience preferred.

Work from Home Requirements

  • Designated Work Area: Remote Workers are required to maintain a separate, designated work area at home

  • Minimum Technical Specifications Home Internet Connectivity: Download and Upload

  • 10Mbps
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Posted 1 week ago

VIEW JOBS 10/9/2019 12:00:00 AM 2020-01-07T00:00 Do you want to be a part of a family and not just another employee? Are you looking for a work environment where diversity and inclusion thrive? Submit your application today and find out what it truly means to be a part of a team. At HCA Healthcare, you have options. You can choose from a variety of benefits to create a customizable plan. You have the ability to enroll in several medical coverage plans including vision and dental. You can even select additional a la carte benefits to meet all your needs. Enroll in our Employee Stock Purchase Plan (ESPP), 401k, flex spending accounts for medical and childcare needs, and participate in our tuition reimbursement and student loan repayment programs. HCA Healthcare is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious Underpayments Analyst to help us reach our goals. Unlock your potential here! As an Underpayment Analyst, you will be responsible for researching and resolving Underpayments. What you will do in this role: * Perform and validate discrepancy reason coding of underpayment inventory * Pursue additional payment from payers on underpayment discrepancies through various means of communication, such as telephonically, online or via payment package processes. * Overcome objections that prevent payment of the claim * Gain commitment for payment through concise and factual collection techniques. * Communicate trends to management as identified * Facilitate correction of non-payment related underpayment discrepancies through I-plan changes or coordination with other departments as needed * Identify and communicate trends to management, including those that might be appropriate for the dispute resolution process * Escalate accounts to appropriate individuals at the payer and via SSC management as needed, including accounts with lack of timely payer response * Utilize effective documentation standards that support a strong historical record of actions taken on the account. * Meet the productivity and quality standards of the organization Work schedule - Monday - Friday (7a-3:30p) EDUCATION High school diploma or GED required. EXPERIENCE One year of related experience required. Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a World's Most Ethical Company by Ethisphere and is ranked in the Fortune 100. We are a family 270,000 strong! Our Talent Acquisition team is reviewing applications immediately. Highly qualified candidates will be promptly contacted by our hiring managers for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. HCA Houston TX

Sr. Underpayment Analyst