Revenue Recovery Specialist
About The Position
The Revenue Recovery Specialist is responsible for monitoring, analyzing, and appealing outpatient-based claim payment variances for behavioral healthcare cases with the goal of optimizing revenue recovery, assessing payor agreement compliance, and communicating reimbursement issues to management. The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.
Requirements
- Bachelor’s degree in Accounting, Business Administration, or other finance-related area is preferred (OR a combination of education and experience resulting in comparable knowledge and abilities).
- 3+ years in business, insurance, or managed care industry settling patient accounts or a related healthcare area such as utilization management, case management, or hospital audit and reimbursement.
- Willingness to submit to drug and background screenings.
Nice To Haves
- Experience in health-related agreements involving rate and language analysis, audit and reimbursement, claims denial, and appeals preferred.
- Knowledge or willingness to learn fundamentals of coding CPT/HCPCS, ICD-10, and DRG is preferred.
Responsibilities
- Use internal data and systems to research delinquent or underpayment accounts, identify and document them, and track and summarize payment variances to determine appropriate actions to be taken.
- Document appeals of payment variances and reimbursement amounts recovered.
- Help develop a knowledgebase and understanding of payor regulations or requirements, terms of Single Case Agreements (SCAs), third-party payor regulations, payment agreements, coverage and benefit plans, coordination of benefits, payment terms, and all other conditions affection payment.
- Analyze internal processes, technical system issues, and payor processing/system issues and determine/communicate corrective actions to resolve payment variances.
- Perform special projects to resolve recovery issues, settle with payors, and optimize revenue recovery.
Benefits
- 21 paid days off (15 PTO days, increasing with tenure, plus 6 holidays)
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options
- Medical, dental, vision, long-term disability, and life insurance
- Generous 401(k) with up to 6% employer match
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
