Spire Orthopedic Partners logo
Spire Orthopedic Partners

Driving the future of orthopedic medicine.

Payer Underpayment Recovery Specialist

GeneralGeneralFull TimeRemoteSeniorTeam 1,001-5,000Since 2021H1B No SponsorCompany SiteLinkedIn

Location

Connecticut

Posted

3 days ago

Salary

$31 - $39 / hour

Seniority

Senior

High SchoolEnglish

Job Description

Payer Underpayment Recovery Specialist

Spire Orthopedic Partners

• Identify potential payer underpayments by reviewing payment data, contractual allowed amounts, fee schedules, EOBs/ERAs, payer policies, claim history, and expected reimbursement calculations • Use Rivet, Modernizing Medicine, Athena, Excel, and payer portals to research reimbursement variances • Validate underpayment opportunities by comparing actual payments to contracted rates • Research payer contracts, fee schedules, reimbursement methodologies • Prepare clear and complete documentation packages to support payer reconsideration • Submit underpayment disputes, reconsideration requests, appeals, and payer inquiries within required payer timeframes • Track underpayment cases from identification through resolution • Maintain Excel-based spreadsheets and trackers to monitor underpayment opportunities • Partner with billing, coding, payment posting, payer collections, contracting, and revenue integrity teams to resolve payment discrepancies • Identify trends by payer, CPT code, modifier, provider, practice, location, system, or contract term and escalate recurring issues • Support reporting on underpayment recovery, revenue impact, payer trends, aged cases, overturn rates, and process improvement opportunities.

Job Requirements

  • Experience in healthcare revenue cycle, payer collections, reimbursement analysis, contract variance review, payment posting, denials, or revenue integrity
  • Experience using Rivet, Modernizing Medicine, Athena, Excel, and spreadsheet-based trackers strongly preferred
  • Intermediate to advanced Excel proficiency required
  • Strong understanding of EOBs, ERAs, payer contracts, fee schedules, CPT/HCPCS codes, modifiers, claim forms
  • Ability to analyze expected versus actual reimbursement and clearly explain payment variances
  • Strong written communication skills
  • Detail-oriented with strong organizational skills
  • Experience with orthopedic, surgical, ASC, or specialty physician billing preferred
  • Knowledge of commercial, Medicare, Medicaid, workers' compensation, bundled payment, and value-based arrangements preferred
  • Bachelor’s degree preferred; relevant healthcare revenue cycle or reimbursement experience may be considered in lieu of a degree.

Benefits

  • Excellent growth and advancement opportunities
  • Dynamic environment
  • Access to a diverse network of practitioners
  • Broad infrastructure of tools and programs to enhance the employee experience
  • Competitive Compensation
  • Generous PTO
  • Health, dental, vision, 401(k), etc.

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