Consultant / Sr. Consultant - Underpayments

Role & responsibilities

• Underpayments as it relates to this position would be a claim that has been adjudicated by a specific payer but has paid less than the amount agreed to in the contract between the payor and the client.
• Have a thorough understanding of payor contracts specifically in comparing the actual payment for a claim to the expected payment.
• Collects, analyses and presents underpayment, recovery and escalation data for assigned clients and team.
• Meets regularly with all impacted individuals to review analysis results, identify improvement opportunities and communicate impact.
• Recommend changes to the review process or workflow to optimize collections.
• Meets with necessary stakeholders, which include client and payer meetings to ensure best practices are in place or fully utilized.
• Provides detailed monthly and/or quarterly summary report that includes current outstanding items, monies collected YTD, expected collections in coming months.
• Completes ad hoc reporting requests from the client or operational teams.
• Payors included for the work of this position are both commercial plans such as UHC, BCBS, and Aetna along with all the New York State Medicaid plans.

Preferred candidate profile:

• This role typically requires a bachelors degree. In lieu of a degree, a comparable combination of education and experience (including military service) may be considered.
• 3+ experience working with providers in operations (e.g. Patient Access, CDM, revenue integrity, Patient Financial Services), compliance, clinical or finance areas.
• Experience and knowledge in federal, state and commercial billing, compliance and reimbursement regulations.
• Experienced in healthcare revenue cycle including complex issue investigation, root cause identification and solution implementation