Join a healthcare revenue integrity team dedicated to helping hospitals recover the reimbursement they are entitled to for the services they provide. In this remote role, you will analyze hospital claims, identify payment discrepancies, and investigate underpayments to ensure accurate and appropriate reimbursement. You will work with insurance carriers and internal stakeholders to resolve billing issues, challenge incorrect payment decisions, and improve revenue recovery outcomes. By applying your knowledge of healthcare billing, coding, payer policies, and reimbursement guidelines, you will help strengthen financial accuracy and operational efficiency. You will also contribute to continuous improvement initiatives by documenting findings, identifying recurring issues, and sharing insights with colleagues. A comprehensive 90-business-day training program will provide structured learning, interactive discussions, and practical exercises to support your success. This opportunity is ideal for a detail-oriented, analytical professional who wants to make a meaningful contribution to healthcare organizations while working remotely.
- Analyze hospital claims using established procedures, technology-enabled worklists, and internal tools to identify discrepancies between expected and actual insurance reimbursements.
- Investigate underpayments and payment variances by examining potential coding errors, billing discrepancies, incorrect payer policy applications, and other reimbursement issues.
- Contact insurance carriers to obtain missing information, clarify payment decisions, resolve underpayment cases, and coordinate payment or adjustment processing on behalf of healthcare clients.
- Prepare and submit the documentation required to support reimbursement recovery, including letters, emails, faxes, online inquiries, appeals, adjustment requests, reports, and payment posting.
- Maintain accurate and comprehensive records of underpayment investigations, root causes, resolution outcomes, emerging trends, and lessons learned to support audit readiness and knowledge sharing.
- Interpret and apply relevant payer reimbursement guidelines, including Medicare, Medicaid, and commercial insurance policies, to support accurate claim assessments and appropriate recovery actions.
- Collaborate with internal teams, insurance representatives, and other stakeholders to resolve complex reimbursement issues and improve claims resolution outcomes.
- Participate in team meetings, discussions, and brainstorming sessions, contributing ideas and recommendations to improve workflows, operational processes, and recovery strategies.
- Uphold ethical standards, confidentiality requirements, and applicable healthcare regulations throughout all reimbursement analysis and recovery activities.
- Perform additional responsibilities as assigned to support revenue integrity operations and organizational objectives.
Requirements
- High school diploma or equivalent is required.
- Strong investigative, analytical, and problem-solving skills, with the ability to identify payment discrepancies, assess complex claim information, and determine appropriate resolution strategies.
- Working knowledge of healthcare billing, medical coding, and reimbursement methodologies, including the ability to understand how billing practices and payer rules affect claim payments.
- Ability to interpret and apply Medicare, Medicaid, and commercial insurance policies, along with relevant healthcare reimbursement regulations and guidelines.
- Familiarity with healthcare compliance requirements, including HIPAA, Centers for Medicare & Medicaid Services (CMS) regulations, and applicable state-specific requirements.
- Experience using healthcare billing systems, databases, or electronic health record platforms such as Epic, Cerner, or Meditech is desirable.
- Proficiency with Microsoft Office applications, particularly Excel, Word, and Outlook, along with the ability to navigate multiple software applications and computer screens simultaneously.
- Excellent attention to detail and organizational skills, ensuring accurate claim analysis, thorough documentation, and compliance with established procedures.
- Effective written and verbal communication skills, including the ability to correspond professionally with insurance carriers and collaborate with internal and external stakeholders.
- Previous remote work experience is preferred, with the ability to manage tasks independently, remain productive, and communicate effectively in a remote environment.
- A dedicated home workspace that is quiet, distraction-free, and suitable for professional work, with sufficient room for workstation equipment and related materials.
- A secure and reliable home internet connection with minimum speeds exceeding 20 Mbps for downloads and 10 Mbps for uploads.
- Location eligibility: Applicants must reside in the United States in one of the following eligible states: Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (Central Standard Time zone), Tennessee, Texas (Central Standard Time zone), Vermont, Virginia, Wisconsin, or West Virginia.
- Eligibility to work in the United States, successful employment history verification, and completion of a background check are required.
Benefits
- Remote work: Full-time remote opportunity for eligible candidates residing in approved U.S. states.
- Comprehensive onboarding: A structured 90-business-day training program beginning on the first day, featuring instructor-led sessions, interactive discussions, and hands-on learning activities.
- Professional development: Opportunities to strengthen healthcare reimbursement knowledge, claims investigation skills, and revenue integrity expertise.
- Collaborative environment: A supportive team culture that encourages knowledge sharing, innovation, and continuous process improvement.
- Meaningful impact: The opportunity to help hospitals recover appropriate revenue and support the financial sustainability of healthcare services.
- Inclusive workplace: A commitment to equal employment opportunities and a professional environment that values individuals from diverse backgrounds.
