Denials Recovery Analyst

Revecore

68d

About The Position

Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further.

Requirements

• Minimum 2 years of insurance billing, denial management and/or utilization review experience
• Experience reviewing and analyzing hospital claims
• Knowledge of healthcare codes including CPT, ICD-9, ICD-10, HCPC, DRG, and ability to correctly use and apply codes in operational setting
• High school diploma or equivalent
• Working knowledge of Microsoft Office suite (Word, Excel)
• Moderate computer proficiency
• Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
• Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to write routine correspondence (in English)
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong customer service orientation
• Excellent interpersonal and communication skills
• Commitment to company values

Responsibilities

• Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims
• Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
• Review insurance contracts to gain thorough understanding of payment methodologies
• Contact insurance company to obtain missing information, explain and resolve denials and arrange for payment or adjustment processing on behalf of client
• Follow up on claims in a timely fashion as outlined in Revecore and/or departmental policies and procedures
• Document information in appropriate Revecore and client systems
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel
• Communicate with client contact concerning all issues related to billing, posting, contracts and all other client related issues, both in an informal manner through daily contact and formal manner through scheduled meetings
• Promotes positive public relations for Revecore, including maintaining a professional attitude and approach with all payors
• Build strong, lasting relationships with clients, payors and Revecore personnel
• Support and direct claims to all Revecore departments and client onsite analysts
• Attend client, department and company meetings
• Comply with federal and state laws, company policies and procedures
• All other duties as assigned

Benefits

• Paid training and incentive plans
• Medical, dental, vision, and life insurance benefits available from the first day of employment
• Excellent work/life balance
• Employee Resource Groups build community and foster a culture of belonging and inclusion
• 401(k) contributions matched
• Career growth opportunities
• 12 paid holidays and generous paid time off

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees