Underpayment Analyst

Our Company

Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further.

As part of our team, you’ll be rewarded with: 

• Competitive compensation with eligibility for a quarterly bonus
• Comprehensive medical, dental, vision, and life insurance benefits from day 1
• 12 paid holidays and flexible paid time off    
• 401(k) with company match   
• Employee Resource Groups that build community  
• Career growth opportunities   
• An excellent work/life balance 

Location: Remote-US 

As an Underpayment Analyst within our Revenue Integrity team, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide.  Your role involves examining hospital claims to verify proper reimbursement and work with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies.  Strong analytical skills, attention to detail, and problem-solving skills are essential in this role.

Training:

Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences.

Responsibilities:

• Utilize company best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers
• Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies
• Contact insurance companies to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
• Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization
• Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes
• Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities
• Other duties as assigned

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Education/Licensing/Certifications:

• High school diploma or equivalent required

 Work Experience & Skills:

• Investigative and problem-solving skills to identify underpayments and discrepancies
• Knowledge of healthcare billing, coding, and reimbursement methodologies
• Strong analytical abilities to dissect complex guidelines and understand their implications on claims reimbursement
• Ability to navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines
• Detail-oriented approach to ensure accuracy in applying guidelines and documenting findings for audit and compliance purposes
• Effective communication skills to collaborate with internal teams, payers, and external stakeholders
• Experience with healthcare billing software and databases (EPIC, Cerner, Meditech)
• Familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.
• Moderate computer proficiency including MS Excel, Word, and Outlook
• Possess technical proficiency to work on multiple computer screens and software applications simultaneously
• Previous experience working in a remote environment

Physical Demands & Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands:

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to handle or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work at Home Requirements:  

• A quiet, distraction-free environment to work from in your home.   
• A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required. 
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.   

Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check.

  
Revecore is an affirmative action-equal opportunity employer that does not discriminate based on race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status.

We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply.

Must reside in the United States within one of the states listed below:

Alabama, Arkansas, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin