Revenue Recovery Consultant, RN

HHC • Indianapolis, IN

31d

About The Position

The Clinical Revenue Recovery Consultant is responsible for monitoring, analyzing, and appealing government, managed care, and commercial payer hospital and outpatient hospital-based patient claim payment variances to optimize revenue recovery, assess contract compliance, and communicate contract and reimbursement issues to management.

Requirements

• RN, current state licensure required
• Two years of Utilization Review experience

Nice To Haves

• CDI experience preferred
• Revenue Cycle experience strongly preferred

Responsibilities

• Perform a variety of tasks related to developing a knowledge-base and understanding of government payer regulations, terms of third party payer regulations and contracts, coverage and benefit plans, coordination of benefits, DRG and clinical validation assignment, payment terms and all other conditions affecting payment, appeal of payment variances and correct payment calculation.
• Use internal data and systems to identify, document, track and summarize payment variances to determine appropriate actions to be taken so as to initiate appeals and to address inaccurate reimbursement in a timely manner.
• Analyze internal processes, technical system issues and payer processing/system issues and determine/communicate corrective actions in order to resolve payment variances.
• Perform a variety of tasks, in conjunction with Managed Care Contracting and Government Payers Department staff, to achieve most accurate payer and contract modeling in the decision support system.
• Document appeals of payment variances and reimbursement amounts recovered through the various appeals processes.
• Must act as a change agent within the organization on current processes to improve documentation
• Works collaboratively with internal and external customers to ensure accurate and compliant documentation and utilization of resources
• Recommends audit and documentation policy changes/new policies to Manager as necessary to ensure compliance
• Perform special projects, as assigned

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed