Operations Specialist

Revecore

10d•Remote

About The Position

As an Operations Specialist at Revecore, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. In this role you will leverage subject matter expertise to improve the accuracy, quality and prioritization of claims delivered to our analyst worklists. Each day may look a little different as you balance the various responsibilities of supporting your team; however, a portion of your time will be reserved to test and provide insights on new AI models that will improve results for your team, for Revecore and our Clients.

Requirements

Want to grow a career
Have moderate working knowledge of Microsoft Office (Word, Excel, Outlook)
Possess technical proficiency to work on multiple computer screens and software applications simultaneously
Can maintain strong performance in a fast-paced environment with productivity metrics
Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies
Have a working knowledge of healthcare billing, coding, and reimbursement methodologies
Can navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines.
Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech)
Have familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.
Excellent verbal and written communication skills to convey complex information to individuals with minimal healthcare or claims background.
A quiet, distraction-free environment to work from in your home.
A secure internet connection is required.
Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.

Responsibilities

Provide training and onboarding support to new analysts as outlined in the Training and Development Onboarding programs.
Provide assistance to address analysts' technical questions and needs on claims handling.
Participate in the quality assurance process for the department, ensuring all applicable guidelines/ deadlines are successfully achieved.
May review and approve adjustments on claims, up to a predetermined amount.
Review claims associated with new AI models that will drive improvements in the assignment and prioritization of claims in the future.
Utilize subject matter expertise to research and identify new underpayment opportunities outside of technology enabled worklists.
Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies.
Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities.