Direct Recruiters Inc.
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.
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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.
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