Job #2630: Healthcare

San Diego, CA 92108

Posted 1 month ago

Job Description

Job #2630: Healthcare

Job Code:#2630

Title:Underpayment Management Specialist

Job Type:Contract

Job Location:San Diego CA

Job Description:


Global Service Resources, Inc.,a leading Healthcare staffing company has opening’s for Underpayment Management Specialist at our local government client location: Rady Children’s Hospital.


Department- Denials Management

Shift- M-F 8:30am-4:30pm Duration- 13 weeks, possible extension

Underpayment Management Specialist Audits bills for account payment, accurate Managed Care Contracts & government fee schedules, re-billing & follow-up on open inventory. Conduct Managed Care payment reviews - audits of HMO, PPO, Managed Medicare/Medicaid, workers- compensation & TRICARE accounts to ensure RCHSD receives full reimbursement from health plans & insurance/workers- compensation carriers. Review Managed Care account activity from Epic, Chartmaxx, & Ancillary Systems. Work with Managed Care Department, payer contracts, & claims processing units to identify root cause & present issues to the appropriate level for resolution. Review zero balance patient accounts (receivables) in conjunction with a detailed contract analysis to ensure payments received are in accordance with the terms of the managed care contract or fee schedule. When the terms of the contract are not properly executed, identify, analyze & recoup underpaid amounts. Facilitate status meetings with the PFS staff to discuss the underpayment findings & make recommendations to maximize reimbursements. Facilitate status meetings with Contracting staff to help clarify language interpretations & negotiate practical compliance terms. Create all necessary reports & presentations based on department & organizational goals. Monitor underpayments; perform global audits on payment variances & payer issues/contract issues.


+ EPIC Experience -Denials & follow up experience

+ Must possess proven ability to track & trend payer-specific issues & report findings to the Managed Care department to support modifications in payer negotiations.

+ Supply monthly reporting by type, dollar amount, & resolution.

+ School Education • Bachelor's Degree (Preferred) H.S. Diploma, GED, or Equivalent (Minimum)

+ Experience • 2 Years of Experience (Minimum) • 4 Years of Experience (Preferred)

+ Licenses & Certifications: Cert Patient Account Manager (Preferred)/Cert Patient Account Tech (Preferred)


At Global Service Resources Healthcare,we concentrate on building careers and we offer attractive compensation packages.

+ Medical Insurance

+ Vision Insurance

+ Prescription Drug Card Coverage

+ Paid Private Housing or Housing Stipend

+ Paid Travel Allowance

+ Mileage Reimbursement

+ 401(K) savings plan with employer match (soon to come)

+ Hours Bonus

+ Referral Bonus Program

+ Free Direct Deposit

+ Paid Professional Liability insurance

+ Paid training

+ Continuing Education assistance

*Benefits available according to company policy

References will be requested if called for an interview.

Since the job needs to be filled immediately please email your resume as soon as possible.

We will contact you on receipt!

Thank you,

Global Service Resources, Inc.

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