Contract and Underpayment Specialist

Salary: $34.95 - $54.87 Hourly

Location: 955 Powell Ave SW, Renton, WA 98057 

Would you like to have a career that makes a daily difference in people’s lives? Do you want to be part of a caring, respectful, diverse community? If you answered yes to these questions, keep reading!

HealthPoint is a community-based, community-supported and community-governed network of non-profit health centers dedicated to providing expert, high-quality care to all who need it, regardless of circumstances. Founded in 1971, we believe that the quality of your health care should not depend on how much money you make, what language you speak or what your health is, because everyone deserves great care.

Position Summary:

The Contract and Underpayment Specialist is a key member of the Revenue Cycle department, responsible for analyzing and managing contracts, identifying underpayments, and ensuring timely and accurate resolution of underpayment issues. This position works closely with payer representatives, internal departments, and external stakeholders to review payer contracts and resolve discrepancies, ensuring that the organization receives appropriate reimbursement for services provided.

This role is critical in ensuring that healthcare providers receive the appropriate reimbursement for the services they provide while optimizing the overall efficiency of the revenue cycle department. The ideal candidate will possess a strong understanding of payer contracts, a keen eye for underpayment issues, and the ability to manage complex billing disputes effectively. Compensation is dependent on skills and experience.

Your contribution to the team includes:

• Analyze payer contracts and agreements to ensure reimbursement terms align with negotiated terms and regulatory guidelines.
• Interpret payer contract language and identify opportunities for revenue optimization and cost reduction.
• Maintain an in-depth understanding of payer contracts, including fee schedules, reimbursement rates, and payment structures.
• Review and monitor underpayments from insurance companies and other payers.
• Investigate and research denied or incorrectly paid claims by comparing contract terms with actual payments.
• Initiate timely appeals and resolution processes for underpaid claims, ensuring all discrepancies are documented and escalated as needed.
• Collaborate with internal billing teams to ensure proper submission of corrected claims and timely follow-ups.
• Work closely with payers and insurance companies to resolve payment discrepancies and underpayments in a timely manner.
• Serve as a point of contact for payer-related underpayment issues, communicating effectively with internal departments, including billing, coding, and legal teams.
• Collaborate with the IT department on payer contract configuration, including participation in the build and testing phases to ensure accurate reimbursement logic is implemented
• Provide regular updates and status reports on underpayment recovery efforts to management.
• Maintain accurate records of underpayments, including tracking claim status and resolution outcomes.
• Generate reports for management detailing underpayment trends, payer performance, and recovery efforts.
• Assist in the preparation of compliance reports and audits as required.
• Maintain thorough documentation of payer contracts and reimbursement terms over time to support historical reference, contract validation, and audit readiness.
• Ensure compliance with all federal, state, and payer-specific billing, coding, and reimbursement regulations.
• Stay informed on changes in healthcare billing policies, payer regulations, and industry standards that may impact contract and payment negotiations.
• Assist in contract negotiations with new and existing payers as needed.
• Contribute to process improvement initiatives across the Revenue Cycle team.
• Maintain good attendance, is punctual and works full scheduled shift is a condition of employment.
• Demonstrate respectful, professional and appropriate behavior that supports a team-oriented work environment.
• Demonstrate a commitment to the mission, core values and goals of HealthPoint and its healthcare delivery including the ability to integrate values of justice, respect, compassion, excellence and stewardship into appropriate programs and services.
• Other duties as assigned by supervisor.
• Attend staff meetings, in-service meetings and participate in agency committees and task force activities as required.

Must have’s you’ll need to be successful:  

• Candidate must obtain Epic certification in the Contract Management module within 90 days of hire. Support will be provided for training and certification preparation.
• High school diploma or equivalent required; associate or bachelor's degree in healthcare administration, Business, or related field preferred.
• Minimum of two (2) years’ experience in healthcare revenue cycle management, specifically in contract analysis payer negotiations, and underpayment resolution. Familiarity with healthcare claims processing, payer systems, and reimbursement methodologies.
• Knowledge of computer equipment required. Proficient in healthcare management software and Microsoft Office Suite. Knowledge of CPT, ICD-10 codes, and healthcare billing guidelines preferred.
• Ability to read, analyze, and interpret common industry related journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write reports and articles for publication that conforms to prescribed style and format. Ability to effectively present information to top management, clients, external groups, and/or boards of directors.

If you know about the following it’s a plus:

• Experience with medical coding, billing systems, and healthcare payer regulations.

Proof of vaccination for COVID-19 is required, prior to start.  HealthPoint does not accept the Johnson & Johnson COVID-19 vaccine as proof of vaccination.  If you have received the Johnson & Johnson vaccine, we ask that you provide documentation demonstrating proof of an alternate COVID vaccine or vaccine series. All new employees are also required to show proof of immunizations and/or immunity to MMR (measles, mumps, rubella), Varicella, annual Influenza and TB QuantiFERON Gold Titer. Additionally, if you work in a HealthPoint clinic, Tdap (within last 10 years) is required. Hepatitis B. is required for clinical employees with potential exposure to blood/blood products. All immunizations are a condition of employment. Upon hire, employees must provide proof of their immunizations and/or immune titer results prior to starting or no later than their fifth (5) business day of employment.

Where to gather your records:

• If you are providing immunizations from an electronic health record, please ensure that you obtain a copy of your full records rather than a screenshot. Each page of your records should include your first and last name, date of birth, and the name of the health system from which the records are pulled.
• If records do not show any data, please seek guidance from your provider for further assistance.
• If you are unable to provide proof as noted above, you can choose to have a lab titer drawn to check immunity or to be re-vaccinated. If you receive vaccination(s) or lab titers, you may obtain them through HealthPoint at no cost to you. This is a great opportunity to get your immunization record up to date at no additional expense.

HealthPoint is committed to offering all employees a competitive compensation package, including benefits and several other perks.

• Medical, Dental, and Vision for employees and their families/dependents
• HSA, FSA plans
• Life Insurance, AD&D and Disability Coverage 
• Employee Assistance Program 
• Wellness Program
• PTO Plan for full-time benefited and part-time benefited employees. 0-.99 years of service accrual of 5.23 hours per pay period. (pro-rated accruals for part-time benefited employees)
• Extended Illness Time Away of 40 hours (pro-rated for part-time benefited employees)
• 8 holidays and 3 floating holidays 
• Compassion Time Away up to 40 hours
• Opportunity Time Off (extended time off for staff to invest in themselves) up to 8 weeks
• Retirement Plan with Employer Match 
• Voluntary plans at a discount, such as life insurance, critical illness and accident insurance,  identity theft insurance, and pet insurance.  
• Third Party Perks Discounted Movie Tickets, Travel, Hotels, and more 
• Development and Growth Opportunities

To learn more about HealthPoint, go to www.healthpointchc.org! #practiceyourpassion

It is the policy of HealthPoint to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex (including pregnancy), age, national origin, marital status, military status, sexual orientation, because of sensory, physical, or mental disability, genetic information, gender identity or any other factor protected by local, state or federal law, and to prohibit harassment or retaliation based on any of these factors.