Revenue Recovery Specialist (remote)

Cognizant•Earth City, MO

2d•$50,000 - $55,000•Remote

About The Position

In this role, you will work under the general supervision of the Director of Managed Care, Credentialing, and Denial Prevention. You will perform advanced-level tasks related to healthcare payer claim line underpayments. Excellent written and verbal communication skills, proficiency in MS Excel, and familiarity with payer portals are essential.

Requirements

High school diploma or GED is Required
RCM experience needed 3-5 years
Healthcare Collections experience 3-5 years
Excel knowledge- Pivot tables

Responsibilities

Utilizing the Advanced Reimbursement Analysis (ARM) tool to identify, track, and trend underpayments.
Possessing a basic understanding of the entire RCM process.
Maintaining a comprehensive knowledge of HCPCS/ICD/CPT coding and specific carrier requirements.
Identifying trends and patterns to better resolve accounts and generate bulk payments.
Recognizing problems or trends and providing suggestions for resolutions.
Demonstrating strong knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes.
Analyzing claim lines to identify contractual underpayments or billing errors.
Resolving underpaid claims from various payer products, including HMO, PPO, Medicaid, Medicare, and Workers' Compensation.
Articulating contract provisions to representatives from healthcare payer companies and government agencies.
Contacting payer via phone, portal, or written correspondence to initiate payment requests.
Performing appropriate follow-up with payers and gaining commitment for payment.
Escalating lack of response or payment within the payer organization as appropriate.
Identifying and communicating contract interpretation issues and language discrepancies to leadership.
Identifying payer trends and communicating them to the supervisor for further action or escalation.
Serving as a subject matter expert in the payer contract dispute resolution process.