AR Recovery/Healthcare Denials Specialist III

FinThrive

About The Position

Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve. We’re looking for an experienced Healthcare Denials Specialist to analyze and resolve payer denials and underpayments. You'll be part of a dynamic team using cutting-edge ARO software to streamline medical claims and collections. As a Denials Specialist II, you will also have the opportunity to mentor junior representatives. Reps typically demonstrate the aptitude and ability to take on critical processes while managing quality production standards. Acts as a mentor to Rep I & Rep II associates. Responsible for managing moderately complicated insurance denials and underpayments via the Rubixis AR Follow Up software.

Requirements

5+ years Hospital Billing with follow up experience, with advanced knowledge of all pay or types, who will be able to manage day-to-day operational tasks associated with medical insurance billing and follow
Knowledge of Medicare payer rules, processes, including how to interpret denial reasons, how to submit appeals to Medicare payer, and access Medicare portals
Ability to use Medicare Direct Data Entry (DDE) to submit claim corrections, adjustments, and inquiries as needed
Detailed understanding of insurance follow-up (i.e., resolving non-paid, denied, under-paid, and rejected claims) for healthcare providers
Experience in UB04 Facility Pricing and Reimbursement variance
Good understanding of revenue cycle
Basic understanding of HIT systems like EPIC, Paragon, Zirmed, or other billing systems
Problem solving / superior analytical skills
An organized and detail-oriented aptitude

Nice To Haves

Bachelor’s or associate degree
2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of both pricing and reimbursement variances
2+ years of experience with Medicare processes and systems
Detailed knowledge of Facility Reimbursement contracts, fee schedules, reimbursement procedures
Advanced MS Excel skills

Responsibilities

Learn and understand our Rubixis platform and the various resources available
Work an assigned number of accounts from start to finish successfully, and in a timely manner
Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues
Analyze contract, billing, cash costing, pricing, and collections on accounts in compliance with billing regulations, policies, and Procedures
Investigate all insurance payments that deviate from expected payment
Work collaboratively with leadership and other team members to confirm, challenge, or provide trending and solutions