Revenue Cycle Underpay Analyst

This role offers:

Duties you will be responsible for:

• Essential Functions include but are not limited to the following:
• Review paid claims to identify reimbursement discrepancies and underpayments.
• Analyze payer reimbursements against contract terms, fee schedules, and reimbursement methodologies.
• Calculate expected reimbursement amounts and quantify variances.
• Initiate and track underpayment recovery efforts through appeals, reconsiderations, and payer escalations.
• Maintain detailed documentation of findings, recovery actions, and outcomes.
• Interpret managed care contracts, payer fee schedules, and reimbursement policies.
• Monitor payer compliance with contractual obligations.
• Identify systemic reimbursement issues and recommend corrective actions.
• Collaborate with Contracting teams to address recurring payer payment discrepancies.
• Develop and maintain underpayment tracking reports and dashboards.
• Analyze reimbursement trends and identify opportunities for revenue recovery.
• Quantify financial impact of payer underpayments and present findings to leadership.
• Prepare monthly and quarterly recovery reports.
• Partner with AR, Coding, HIM, Credentialing, and Contracting teams to resolve reimbursement issues.
• Support payer meetings by providing detailed underpayment analysis and supporting documentation.
• Assist in root cause analysis for denials, payment variances, and payer processing errors.
• Participate in revenue integrity initiatives designed to optimize reimbursement.
• Ensure all recovery activities comply with payer requirements, contractual obligations, and regulatory guidelines.
• Maintain confidentiality of patient and financial information in accordance with HIPAA regulations.
• Stay current on reimbursement methodologies, payer policies, and industry best practices.

Minimum Requirements

• Minimum of 3 years of experience as a Business Analyst in healthcare settings
• Experience with a large, growing healthcare organization.
• Technical or Administrative Knowledge:
• Ability to manage multiple priorities and meet deadlines.
• Strong attention to detail and accuracy.
• Ability to present financial findings to operational and executive leadership.
• Required Skills and Abilities and/or:
• Strong analytical and critical thinking skills.
• Ability to interpret complex payer contracts and reimbursement methodologies.
• Excellent written and verbal communication skills.
• Strong organizational and project management abilities.

We offer a comprehensive benefits package to our eligible employees:

• Medical
• Dental
• Vision
• Spending Accounts
• Life / AD&D
• Disability
• Accident
• Critical Illness
• Hospital Indemnity
• Legal
• Identity Theft
• Pet
• 401(k) retirement plan with Non-Elective Safe Harbor employer contribution for eligible employees
• Discretionary profit-sharing with employer contributions of 0% - 4% for eligible employees
• Additionally, Gastro Health participates in a program called Tickets at Work that provides discounts on concerts, travel, movies, and more.
• Gastro Health is the one of the largest gastroenterology multi-specialty groups in the United States, with over 130+ locations throughout the country. Our team is composed of the finest gastroenterologists, pediatric gastroenterologists, colorectal surgeons, and allied health professionals. We are always looking for individuals that share our mission to provide outstanding medical care and an exceptional healthcare experience. We offer a comprehensive benefits package to our eligible employees.
• Gastro Health is proud to be an Equal Opportunity Employer. We do not discriminate based on race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
• We thank you for your interest in joining our growing Gastro Health team!