Specialist, Revenue Recovery
About The Position
This role is focused on maximizing revenue for our Insource hospital clients by meticulously investigating, analyzing, and resolving technical claim denials and complex contractual underpayments. As a specialist, you will leverage your existing accounts receivable expertise and our advanced technology platform, Health Innovas "Pulse," to uncover hidden revenue opportunities and ensure our clients are reimbursed fully and accurately for the care they provide. This position offers a unique career development opportunity for high-performing team members to become subject matter experts in the most challenging and rewarding areas of the revenue cycle.
Requirements
- Strong foundational understanding of the healthcare revenue cycle, including claims submission, remittance processing, and follow-up.
- Demonstrated analytical and critical thinking skills with a high level of attention to detail.
- Excellent written and verbal communication skills, with the ability to clearly and concisely document account activity.
- Proficient with computers and technology, with an aptitude for quickly learning and mastering new software platforms.
- Prior experience specifically in denial analysis or underpayment identification.
- Familiarity with reading and interpreting payer contracts and fee schedules.
- Experience working within various payer portals and systems.
- High School Diploma or equivalent required
- Minimum of 2+ years of experience in healthcare accounts receivable (AR), hospital billing, or revenue cycle resolution.
- Experience working within various payer portals and systems.
Nice To Haves
- Associate's or Bachelor's degree in a related field preferred.
Responsibilities
- Utilize the Health Innovas "Pulse" platform to systematically review client accounts flagged for potential denials or underpayments.
- Conduct deep-dive investigations into technical denials, including those related to eligibility, registration errors, missing authorizations, and other administrative issues.
- Analyze explanation of benefits (EOBs) and compare actual payments against modeled payer contracts to precisely identify and quantify contractual underpayments.
- Correct data errors and resubmit claims in a timely manner to resolve technical denials.
- Prepare detailed documentation and justification to support underpayment appeals and resolution efforts.
- Collaborate with Clinical Appeals Specialists (RNs) and Certified Coders by gathering necessary documentation for complex clinical and coding-related denials.
- Diagnose the root cause of each denial and underpayment to identify trends by payer, service line, and denial reason.
- Meticulously document all actions, findings, and communications within the Pulse platform to ensure a clear audit trail and support team collaboration.
- Contribute to performance reports that provide actionable insights to both internal leadership and clients, helping to prevent future revenue leakage.
- Serve as a key resource for resolving complex payment issues, working alongside Payer Contract Specialists and Denial Management leadership.
- Participate in ongoing training to master the Pulse platform and stay current on evolving payer rules and denial trends.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
