Revenue Recovery Specialist - 24-181

$66,560 - $72,480/Yr

Hill Physicians Medical Group - San Ramon, CA

Full-time - Entry Level

San Ramon, CA

About the position

The Revenue Recovery Specialist at Hill Physicians Medical Group is responsible for maximizing health plan reimbursements through various contractual recovery programs. This role involves analyzing claims, submitting requests, and ensuring compliance with HIPAA regulations while working closely with internal and external stakeholders to resolve issues related to claims payments and eligibility.

Responsibilities

• Maximize Health Plan reimbursement related to various contractual Recovery Programs.
• Identify, analyze, submit, review, and recover funds associated with eligibility guarantees, insured services, and drug reimbursement.
• Track and reconcile all claims payment/reimbursement/refund data within the BILL application.
• Ensure scripts and reports are accurate in preparation for submissions, follow-up, and data collection.
• Understand contractual agreements and DFRs to efficiently submit rebuttals, disputes, or appeals for denied/unpaid claims.
• Perform eligibility versus capitation audits and work with various internal and external staff to make necessary updates and request refunds.
• Monitor Medi-Cal maternity payments and ensure timely reimbursement according to contractual obligations.
• Work with Financial Analysis and Accounting staff regarding Recovery Program capitation reimbursements or deductions.

Requirements

• Minimum of 1-3 years of related managed care experience required.
• Strong knowledge of medical terminology.
• Working knowledge of CPT/HCPCS, ICD-10, and NDC codes.
• Data entry/word processing experience/PC experience.
• Strong verbal communication, decision-making, and problem-solving skills.
• Strong organizational skills and detail-oriented.
• Ability to work independently and as a cooperative member of a team.
• Excellent customer service skills.
• Able to multi-task and work in a productivity-based environment.
• Proficient in the use of a claims payment system with a strong understanding of benefit structure.
• Strong knowledge of HPMG rules & Guidelines, COB, Authorizations, Health Plan DFRs, as well as UB and HCFA formats.
• Knowledge of PHI and HIPAA Regulations.
• Familiarity with DMHC, Medi-Cal, Coordination of Benefits, and CMS regulatory requirements.

Nice-to-haves

• College degree or equivalent preferred.