About this role
Revecore is hiring a Remote Underpayment Analyst to help hospitals receive accurate reimbursement for services. The role reviews hospital claims, investigates underpayment reasons, coordinates with insurance carriers, and prepares appeals, adjustments, and payment posting documentation while following regulatory guidelines.
Key Responsibilities
- Identify discrepancies between expected and actual reimbursement using a worklist and internal tools
- Investigate payment variances, coding errors, billing discrepancies, and payer policy misapplications
- Contact insurance companies to obtain missing information and resolve underpayments
- Prepare and submit correspondence including appeals and adjustments
- Maintain documentation of root cause, trends, outcomes, and lessons learned
Technical Overview
The role uses a technology enabled worklist and internal tools to identify reimbursement discrepancies between expected and actual amounts. It involves managing correspondence workflows (letters, emails, faxes, online inquiries) and maintaining structured root-cause and trend documentation to support process improvement.
Ideal Candidate
The ideal candidate is an entry-level or early-career claims reimbursement professional who can analyze hospital claims to identify underpayments and resolve discrepancies with insurance carriers. They are detail-oriented with strong documentation skills, understand payer policies, and can prepare appeals and adjustment correspondence while maintaining compliance with regulatory guidelines.
Must-Have Skills
Utilize company best practices and technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amountsInvestigate reasons for discrepancies (payment variancescoding errorsbilling discrepanciesincorrect application of payer policies)Contact insurance companies to obtain missing information and resolve underpaymentsPrepare and submit correspondence including appeals and adjustmentsMaintain thorough documentation including root causetrendsoutcomesand lessons learnedDemonstrate commitment to ethical standards and compliance with relevant regulations and guidelines
Tools & Platforms
technology enabled worklistinternal toolsonline inquiriesfaxespayment posting
Required Skills
analyze hospital claimsverify reimbursementidentify discrepanciesinvestigate payment variancescoding errorsbilling discrepanciespayer policiescontact insurance companiesobtain missing informationresolve underpaymentsprepare correspondenceappealsadjustmentsreportspayment postingmaintain documentationroot cause analysiscompliance
Hard Skills
Analyzing hospital claimsVerifying proper reimbursementDiscrepancy identification between expected reimbursement and actual reimbursement amountsInvestigating payment variancesInvestigating coding errorsInvestigating billing discrepanciesApplying payer policiesContacting insurance companiesObtaining missing information from insurance carriersPreparing and submitting correspondence (lettersemailsfaxesonline inquiriesappealsadjustmentsreportspayment posting)Maintaining thorough documentation of root causetrendsoutcomesand lessons learnedRegulatory compliance with reimbursement optimization activitiesAppeals and adjustment processing coordinationPayment posting
Soft Skills
Ethical standards commitmentCompliance mindsetCommunication with insurance companiesDocumentation and attention to detailCollaboration with stakeholdersProblem solvingParticipation in meetings and brainstorming sessions
Keywords for Your Resume
Underpayment Analystunderpaymenthospital claimsreimbursementexpected reimbursementactual reimbursementinsurance carrierspayment variancescoding errorsbilling discrepanciespayer policiesappealsadjustmentspayment postingcorrespondenceroot causetrendsdocumentationcomplianceregulatory guidelines
Deal Breakers
Ability to work with hospital claims and reimbursement discrepancy investigation, Demonstrated commitment to compliance with relevant regulations and guidelines
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