AR Recovery – Healthcare Denials Specialist III

This is a fully remote position, open to applicants in United States.

📋 Description

• Acquire knowledge and comprehension of the Rubixis platform and its available resources.

• Successfully manage assigned accounts from initiation to completion within set timeframes.

• Contact healthcare insurance companies, affiliates, and providers to address contract or payment discrepancies.

• Evaluate contracts, billing, cash costs, pricing, and collections on accounts in accordance with billing regulations, policies, and procedures.

• Investigate insurance payments that differ from anticipated amounts.

• Collaborate with leadership and team members to validate, question, or provide insights and solutions.

• Mentor and guide Rep I and Rep II associates.

• Handle moderately complex insurance denials and underpayments utilizing Rubixis AR Follow Up software.

⛳️ Requirements

• Over 5 years of experience in Hospital Billing with follow-up expertise.

• Advanced understanding of all types of payers.

• Familiarity with Medicare payer regulations and processes, including interpreting denial reasons, submitting appeals to Medicare payers, and navigating Medicare portals.

• Proficiency in using Medicare Direct Data Entry (DDE) to make claim corrections, adjustments, and inquiries.

• Comprehensive understanding of insurance follow-up, including resolving unpaid, denied, underpaid, and rejected claims for healthcare providers.

• Proven experience in UB04 Facility Pricing and Reimbursement variance.

• Solid grasp of the revenue cycle.

• Basic knowledge of HIT systems such as EPIC, Paragon, Zirmed, or other billing systems.

• Exceptional problem-solving and analytical skills.

• Organized with a strong attention to detail.

• Bachelor's or associate degree required.

• At least 2 years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of pricing and reimbursement variances.

• A minimum of 2 years of experience with Medicare processes and systems.

• In-depth knowledge of Facility Reimbursement contracts, fee schedules, and reimbursement procedures.

• Advanced skills in MS Excel.

🏝️ Benefits

• Equal Opportunity Employer.

• Employment decisions adhere to the principles of Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.