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Hospital Underpayment Recovery Specialist
- Salary
- $45K–$70K
- Hiring from
- United States
- Work type
- Remote
- Posted
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Benefits:
- 401(k)
- Employee discounts
- Health insurance
- Paid time off
- 401(k) matching
- Dental insurance
- Parental leave
- Training & development
- Vision insurance
- Climb is seeking candidates with VERY specific minimum qualifications (see below).
- This position is restricted to candidates based in the U.S. and as such, only applicants within the U.S. will be considered for this role.
Who You Are
You are experienced in resolving underpayment issues and know how to effectively identify underpayment root causes, then efficiently pursue insurance companies for complete payment. You enjoy working with a dynamic team, helping optimize reimbursement for hospitals and health systems. You have a strong desire to exercise your research skills, a high attention to detail, and a drive to develop subject matter expertise. You are an excellent communicator, a thoughtful problem solver, and you value collaboration. You have a strong work ethic, are driven by continuous improvement, and thrive when working in a team-based and service-oriented environment. You want to join a community-minded place.
Who We Are
Climb Healthcare is a boutique consulting firm dedicated to helping hospitals and health systems increase their revenue while improving performance, allowing them to better support the communities they serve. By working hospital inpatient accounts towards resolution with payers, we identify provider revenue and payer compliance issues that cause payment delays and revenue leakage. We provide high-value insight and help clients implement actionable recommendations that specifically address the underlying issues we identify.
You are experienced in resolving underpayment issues and know how to effectively identify underpayment root causes, then efficiently pursue insurance companies for complete payment. You enjoy working with a dynamic team, helping optimize reimbursement for hospitals and health systems. You have a strong desire to exercise your research skills, a high attention to detail, and a drive to develop subject matter expertise. You are an excellent communicator, a thoughtful problem solver, and you value collaboration. You have a strong work ethic, are driven by continuous improvement, and thrive when working in a team-based and service-oriented environment. You want to join a community-minded place.
Who We Are
Climb Healthcare is a boutique consulting firm dedicated to helping hospitals and health systems increase their revenue while improving performance, allowing them to better support the communities they serve. By working hospital inpatient accounts towards resolution with payers, we identify provider revenue and payer compliance issues that cause payment delays and revenue leakage. We provide high-value insight and help clients implement actionable recommendations that specifically address the underlying issues we identify.
The Role
The Underpayment Resolution Specialist’s primary focus is acute inpatient hospital account resolution. You will apply your expertise (e.g., DOFR, DRG/LOC downgrades, authorization, charge capture, billing, denials) to:
The Underpayment Resolution Specialist’s primary focus is acute inpatient hospital account resolution. You will apply your expertise (e.g., DOFR, DRG/LOC downgrades, authorization, charge capture, billing, denials) to:
- Conduct effective account resolution by calling payers and/or leveraging payer web portals to resolve highly complex account issues;
- Research/identify payment variances and root causes then take actions to collect on them;
- Manage claims inventory by responding timely to payer inquires and requests;
- Utilize patient accounting software and other systems and tools to identify/resolve payment issues;
- Support revenue cycle improvements by identifying reimbursement and payer practice trends;
- Leverage knowledge of payer claims processing procedures and policies to address non-compliant payer behavior.
Other Responsibilities:
- Develop and maintain project and account documentation related to Climb’s project work;
- Stay abreast of industry regulations and trends;
- Assist with on-boarding, training and/or mentoring of new staff, as needed or requested
- Perform other tasks and special projects, as assigned.
Minimum Qualifications:
- Three (3) years of recent experience in COMMERCIAL ACUTE INPATIENT claims UNDERPAYMENT resolution (not only account denials experience);
- Strong, effective and timely performance in resolving and/or collecting payment from insurance plans;
- Knowledge of hospital reimbursement provisions, familiarity with health care payers (mostly commercial, some government), and understanding of regulatory policies;
- Strong interpersonal, oral, and written communication skills to interact with peers, leadership, insurance payers, clinical and non-clinical staff;
- Strong analytical skills to interpret and calculate expected reimbursement from EOBs and payer contracts;
- Experience with hospital revenue cycle/patient accounting software;
- Demonstrated production of high-quality documentation in account notes and appeal letters;
- Able to work independently, work across multiple projects, and maintain a high degree of work ethic, integrity and professionalism;
- Maintain and follow all HIPAA and confidentiality requirements.
Preferred Qualifications:
- Five (5) years of direct experience in COMMERCIAL ACUTE INPATIENT account resolution;
- Direct experience with denials or contract management or five years of equivalent work experience;
- EPIC/EMR or other advanced clinical system software experience or certification;
- Experience working with Microsoft Access.
This is a remote position.
Compensation: $45,000.00 - $70,000.00 per year
