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Trend Health Partners · 11 hours ago

Underpayment Recovery Analyst

United States

Full-time

Remote

Mid Level

$50K/yr - $75K/yr

TREND Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare through collaboration between payers and providers. The Underpayment Recovery Analyst is responsible for reviewing, identifying, and resolving underpaid hospital claims, conducting analyses of claim-level payments, and preparing appeals to optimize client reimbursement.

Health CareHospitalPayments

Responsibilities

Perform detailed analysis of remittances, explanations of benefits (EOBs), payer correspondence, and account detail to identify underpayments or incorrect claim adjudications

Evaluate claim payment variances against expected reimbursements based on client-specific contract terms

Accurately identify and categorize underpayment types and root causes (e.g., pricing discrepancies, DRG/APC miscalculations, bundling errors, inappropriate denials)

Initiate rebilled or corrected claims and manage timely follow-up on outstanding underpaid or denied claims

Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement

Track outcomes and escalate unresolved issues as needed

Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies

Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial)

Identify and document systemic payer issues and trends affecting reimbursement

Partner with internal teams and client stakeholders to recommend process improvements, payer escalations, or system configuration changes

Meet or exceed established internal Key Performance Indicators (KPIs) related to claims reviewed, identifications, recovery amounts, appeal turnaround times, and accuracy

Maintain up-to-date and organized case documentation in internal systems and client-facing portals

Qualification

Healthcare revenue cycleUnderpayment analysisHospital managed care contractsContract modeling toolsPayer reimbursement analysisMicrosoft ExcelAnalytical skillsWritten communicationVerbal communication

Required

Experience in healthcare revenue cycle, with a strong focus on underpayment/zero balance review, and payer reimbursement analysis

Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem)

Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech)

Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes

Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules

Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies

Excellent written and verbal communication skills

Proficient in Microsoft Excel and other data analysis/reporting tools