Underpayment Analyst, Denials - Zero Balance

Key responsibilities

• Review, evaluate, appeal, and follow up on denied, underpaid, and other assigned claims using proprietary software and tools.
• Use payment documentation and provider contract information to determine correct reimbursement.
• Review hospital contracts to identify and collect cash payments from insurance companies.
• Research, request, and acquire medical records and supporting documentation for complex underpayment appeals.
• Conduct timely follow-up with payers to confirm receipt of documentation and resolve outstanding receivables.
• Support smooth operations and customer satisfaction.

Qualifications

• High school diploma or GED required; associate or bachelor’s degree preferred.
• 5+ years of experience in the healthcare field working in billing or collections.
• 1+ year of client-facing or customer service experience.
• Intermediate understanding of insurance payer/provider claims processing and related data requirements.
• Strong computer proficiency, including MS Word, Excel, and Outlook.
• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Strong understanding of revenue cycle processes.
• Knowledge of hospital reimbursement, managed care contracts, contract language, and federal/state requirements.
• Familiarity with HMO, PPO, IPA, and capitation terms.
• Intermediate understanding of EOBs, UB-04, and HCFA 1500 forms.
• Ability to review client and payer contracts to identify complex underpayments.
• Strong communication, analytical, problem-solving, and organizational skills.
• Ability to work independently, manage multiple priorities, and maintain productivity under pressure.

Benefits and perks

• Remote work opportunity
• Full-time employment
• Opportunity to work for a multi-year Top Workplaces recipient
• Professional growth and development opportunities
• Supportive, flexible, and collaborative company culture