Payer Underpayment Recovery Specialist

Spire Orthopedic Partners

Payer Underpayment Recovery Specialist identifying and resolving payer underpayments in the healthcare sector. Collaborating across teams to secure additional payment and improve revenue cycle performance.

Posted 6/30/2026full-timeRemote • Connecticut • 🇺🇸 United StatesMid-LevelSenior💰 $32 - $40 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Comp & perks

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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Reimbursement AnalysisContract Variance ReviewPayment PostingDenials ManagementCPT/HCPCS Code KnowledgePayer Policy ResearchData AnalysisDocumentation PreparationTrend IdentificationProcess Improvement

Soft Skills

Detail-OrientedStrong Organizational Skills