Revenue Recovery Specialist

Avera•Sioux Falls, SD

2d•Onsite

About The Position

Responsible for researching, analyzing and validating accounts to resolve denials, inappropriate payment and non payment of claims. The Specialist will identify, review and interpret third party payments, adjustments, denials, and facilitate appeals. Responsible for taking the appropriate action needed to correct the account, complete the correction or omission, and maintain documented action to follow-up on the collection and optimization of accurate reimbursement for all appropriate payers.

Requirements

The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
Promote Avera’s values of compassion, hospitality, and stewardship.
Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
Maintain confidentiality.
Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Nice To Haves

1-3 years Related experience

Responsibilities

Responsible for account review and follow up on unpaid claims for resolution.
Research for appropriate information and process claims with corrected claim information or appeal.
Reconciles patient accounts to ensure the payment, balance or refund is correct.
Collaborate with internal departments to ensure claim accuracy for timely processing.
Monitor and review payer correspondence for claim processing updates, claim audits and denials, and refund requests.
Serves as a resource to various departments within the Central Business Office to answer questions with regard to network discounts, reimbursement, provider networks, and government payers.
Monitors & reports trending of third party reimbursement issues to next level leader for revenue cycle optimization.