Underpayment Recovery Analyst

​​Role and Responsibilities​

• CLAIMS REVIEW AND ANALYSIS
• Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
• Evaluate claim payment variances against expected reimbursements based on client-specific contract terms.
• Accurately identify and categorize underpayment types and root causes (e.g., pricing discrepancies, DRG/APC miscalculations, bundling errors, inappropriate denials).
• PAYER FOLLOW UP AND APPEALS
• Initiate rebilled or corrected claims and manage timely follow-up on outstanding underpaid or denied claims.
• Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
• Track outcomes and escalate unresolved issues as needed.
• CONTRACTUAL EXPERTISE
• Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies.
• Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial).
• ROOT CAUSE AND TREND IDENTIFICATION
• Identify and document systemic payer issues and trends affecting reimbursement.
• Partner with internal teams and client stakeholders to recommend process improvements, payer escalations, or system configuration changes.
• PERFORMANCE QUALITY
• Meet or exceed established internal Key Performance Indicators (KPIs) related to claims reviewed, identifications, recovery amounts, appeal turnaround times, and accuracy.
• Maintain up-to-date and organized case documentation in internal systems and client-facing portals.

Qualifications

• Experience in healthcare revenue cycle, with a strong focus on underpayment/zero balance review, and payer reimbursement analysis.
• Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem).
• Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech).
• Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes.
• Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules.
• Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies.
• Excellent written and verbal communication skills
• Proficient in Microsoft Excel and other data analysis/reporting tools.

Mental and physical demands

• This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Related duties as assigned

• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.

Originally posted on Himalayas