Underpayment Specialist - Revenue Cycle #29

Who We Are:

St. John’s Episcopal Hospital is the only hospital providing emergency and ambulatory care to the densely populated, culturally and economically diverse, and medically underserved populations of the Rockaways and Five Towns in southern Queens County and southwestern Nassau County, New York. Celebrating over 110 years of community care, the 257-bed facility provides people of all faiths with comprehensive preventive, diagnostic treatment and rehabilitative services, regardless of ability to pay.

Come Grow With Us!

Type: Full-Time

Shift: Days

Hours: 8:00AM - 4:30PM

Pay: $35.39 - $37.03 Hourly

Job Summary:

The Revenue CycleUnderpayment Specialist is responsible for the thorough review, research, and ultimate resolution of denials and underpayments by government, commercial, and client payers. The Specialist will also follow up on any unpaid or underpaid aging claims and determine needed action. The core daily functions will be the resolution of denied and/or underpaid claims, which includes researching accounts, analyzing EOBs, and interacting with insurance companies and government payers. The Specialist must demonstrate high-level problem solving skills to perform root cause analysis on denied and underpaid accounts and extrapolate those causes across large volumes identified as denial trends for assigned accounts. This position requires the ability to evaluate complex account issues and communicate effectively to support the organizational goals for specific key performance indicators as they relate to denials and underpayments management.

Responsibilities:

• Analyze and research reasons for denials or underpayments on each account assigned
• Contact third party payors and patient when necessary to the denials recovery process
• Utilize electronic hospital systems to track correspondence, document follow up/appeals activities, and to confirm receipt and determination of denials appeals
• Understand payor contracts, state/national guidelines, and contract management system
• Make necessary adjustments to patient demographic, insurance, and account balance information
• Process appeals, rebills, adjusted bills, and other requested information to resolve denied claims and track progress until issue is resolved

Requirements:

• Associate Degree required, Bachelor's degree preferred
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required within 1 year of hire
• Strong knowledge of ICD-10, CPT-4, and/or HCPCS coding systems
• 3-5 years experience working in a hospital acute care setting/Revenue Cycle, reimbursement, managed care, or related consulting with a focus on billing
• 2-3 years experience focused on denials and underpayments hospital claims resolution
• Experience working with multiple hospital systems and payer portals, and analyzing healthcare claims
• Understanding of governmental and third-party payer authorization, claim submission, and reimbursement guidelines
• Strong PC skills including word processing and spreadsheets