Client Summary:

• Partners with hospitals and health systems nationwide
• Delivers solutions to resolve complex claims and recover revenue
• Combines technology, expertise, and advocacy to support providers
• Recognized as a trusted, award-winning industry partner

Position Responsibilities:

• Leadership & Strategy
• Lead, manage and coach the underpayment recovery team, fostering accountability, professional growth, and high performance.
• Ensure accurate identification, prioritization, follow-up and resolution of underpaid claims for healthcare clients.
• Establish and execute a comprehensive underpayments strategy aligned with organizational goals.
• Collaborate with the Contracting team to ensure contract terms are built in alignment with contract terms.
• Collaborate with Product and Data teams to ensure payer logic is built in accordance with payer policies and to enhance user experience.
• Operational Excellence
• Develop and maintain standardized workflows and escalation pathways to drive timely and successful resolution of underpayments.
• Oversee daily operations of underpayment workflows, including root cause analysis, appeals, and recovery.
• Implement and optimize tools and technologies to automate and enhance underpayment identification.
• Monitor KPIs and performance metrics to ensure timely and accurate resolution of underpayments.
• Stay current on payer policies, reimbursement trends, and healthcare regulatory changes that impact payment accuracy.
• Analytics & Reporting
• Analyze trends in payer behavior, denial patterns, and reimbursement discrepancies.
• Provide actionable insights and regular reporting to executive leadership on underpayment recovery performance.
• Partner with data and analytics teams to refine dashboards and predictive models.
• Identify and determine requirements for improvements to system to reduce false positives in the underpayment product.

Experience & Skills:
Required Experience and Qualifications:

• Minimum 5–7 years of experience in physician billing or healthcare revenue cycle management, with at least 2 years in a leadership or management role focused on underpayments, denials, or reimbursement.
• Proven experience leading underpayment, reimbursement or revenue integrity teams, with a hands on leadership style.
• Strong knowledge of payer contracts, EOBs, and healthcare reimbursement methodologies.
• Deep knowledge of ANSI X12 formats, specifically 837 claim and 835 remits.
• Experience in reimbursement follow-up.
• Experience with establishing relationships with insurance payers.
• Familiarity with CMS guidelines and commercial payer policies.
• Exceptional analytical and problem-solving skills, with great attention to detail.
• Excellent communication and strong leadership abilities, with a focus on guiding teams toward resolution.
• Proficiency in revenue cycle systems (e.g., Epic, Cerner, Athena) and data tools (e.g., Excel, Tableau, SQL).

Compensation $165k

Our generous benefits package includes plenty of paid time off for full-time employees, along with medical, dental, vision, FSA, HSA, Life and AD&D options to meet you or your family’s needs. We offer a flexible schedule so you can have a more productive and well-balanced life—both in and outside of work. We are committed to a diverse and inclusive workplace.