Note: The job is a remote job and is open to candidates in USA. Aspirion provides revenue cycle services focused on complex payment recovery for healthcare organizations. The Triage Analyst will support the Zero Balance team by reviewing hospital contracts, analyzing healthcare claims and reimbursement discrepancies, identifying denial and underpayment trends, and routing claims for recovery and appeals.
Responsibilities
- Review and interpret hospital contracts with insurance carriers, model claims data, and identify reimbursement discrepancies and revenue recovery opportunities
- Research and monitor federal, state, and payer-specific regulations related to hospital reimbursement methodologies; collaborate with technical teams to develop and implement audit flags that identify emerging underpayment trends
- Analyze large and complex healthcare claims data sets to identify underpayment, denial, and reimbursement variance trends
- Evaluate contract modeling results and validate payment variances by analyzing claim-level data, determining scope, recoverability, and appropriateness for zero-balance audit review
- Identify, analyze, and communicate underpayment trends and revenue recovery opportunities; partner with Customer Success and Client Performance teams to ensure appropriate claims are routed through the recovery pipeline
- Provide revenue intelligence and operational insights to support client performance initiatives, reimbursement optimization, and strategic decision-making
- Identify underpayment and denial root causes and assign appropriate denial categories (e.g., authorization, eligibility, coding, medical necessity, timely filing, registration, billing, payer processing)
- Review documentation from payer portals, client systems, provider notes, explanation of benefits (EOBs), remittance advice, and other sources to understand account history and claim status, communicate with insurance carriers and internal stakeholders as needed to clarify claim status, and support the development of comprehensive appeal submissions
- Maintain accurate documentation of denial actions, findings, and escalation activities
- Prioritize denials based on financial impact, aging, contractual requirements, and appeal deadlines
- Route denied claims to the appropriate resolution pathway based on denial type, payer requirements, and supporting documentation
- Adapt quickly to new technologies, software platforms, automation tools, reporting systems, and process enhancements in a rapidly evolving operational environment
- Ensure compliance with payer guidelines, regulatory requirements, and organizational policies
- Work independently and collaboratively to achieve productivity and quality goals
- Follow organizational policies, payer guidelines, and regulatory requirements including HIPAA
- Demonstrate integrity and ethics in day-to-day tasks and decision making, operate effectively in the environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
- Support Compliance Program by adhering to policies and procedures pertaining to HIPAA, GLBA, FCRA, and other laws applicable to business practices; this includes becoming familiar with Code of Ethics, attending training as required, notifying management when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
- US remote-based colleagues are not permitted to work from a location outside of the United States, at any time, without prior, written approval
- Fully remote position
Skills
- High school diploma or equivalent required
- Strong analytical and critical thinking skills with the ability to evaluate denial root causes
- Strong written and verbal communication skills
- Ability to multi-task and manage competing priorities
- Proven ability to learn and adopt new technologies, software applications, and operational processes quickly
- Ability to research and interpret insurance information and benefits
- Strong attention to detail and accuracy in documentation
- Ability to work independently in a fast-paced environment
- Reliable attendance and consistent performance
- US remote-based colleagues are not permitted to work from a location outside of the United States, at any time, without prior, written approval
- Fully remote position
- Bachelor's degree preferred or equivalent combination of education and experience
- Prior experience in healthcare revenue cycle or denial management environments
- Experience with denial analytics platforms and payer portal navigation
- Experience in identifying denial root causes and applying critical thinking to support accurate triage and routing
- Familiarity with insurance carriers and payer guidelines
- Demonstrated ability to identify trends and process improvement opportunities
- Experience working in a productivity and quality metrics-driven environment
- Remote work experience in a structured environment
- Experience working with EMR systems such as Epic or similar platforms
Benefits
- Fully remote position.
Company Overview