Revenue Recovery Specialist

This is a fully remote position, open to applicants in Arizona, +21 more states.

📋 Description

• Evaluate and rectify a minimum of 25–30 accounts daily that have been incorrectly denied or underpaid by insurance providers.

• Investigate denied claims, collaborate with teammates, process appeals, resolve denials for appropriate payment, and identify underpayment variances.

• Detect insurance underpayments and denials for hospital patient accounts, which include zero payments, full denials, line-item denials, billing corrections, updated billing code requirements, and incorrect payer system setups.

• Track denial and appeals data for payer, provider, or departmental denial and variance trends.

• Communicate trends to management and suggest process improvement initiatives.

• Review aging appeals and problematic cases.

• Confirm insurance payments for accuracy and adherence to contract terms and fee schedules.

• Identify root causes of insurance reimbursement underpayments and implement measures to resolve payment variances, focusing on high-dollar recoveries.

• Examine claims and insurance remittances to investigate denials and variances, including discrepancies in coding, billing, and insurance information.

• Collaborate with facilities to submit corrected claims and appeals.

• Document variance or denial reasons in patient accounts and update accounts using predefined reason codes.

• Reach out to insurance providers regarding denials and underpayments.

• Adhere to insurance payer guidelines and follow up until account resolution is achieved.

• Assist with outstanding insurance payment follow-ups, including payment status verification, rebilling, proration, and account notation.

• Build relationships with third-party payer representatives to resolve claim issues.

• Complete operational improvement and reimbursement increase projects.

• Perform additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent is required.

• 3 to 5 years of relevant experience, primarily in Hospital Billing, Insurance follow-up, Denial resolution, or similar roles, with at least 3 years in a hospital patient accounts department or equivalent.

• Customer service-oriented.

• Proficient in computer use, including Microsoft Office Suite/Teams and GoToMeeting/Zoom.

• Familiarity with computer applications or other automated systems, such as Excel spreadsheets, Word, email, and database software.

• Intermediate understanding of hospital billing, revenue cycle, and medical terminology.

• Intermediate knowledge of revenue cycle processes impacting reimbursement, including intake, admissions, registration, billing, accounts receivable, denials, account follow-up, cash posting, payer logs, and aging AR management.

• Intermediate knowledge of CPT, HCPCS, and ICD-10 coding is required.

• Capability to navigate healthcare information systems and Clearinghouses to identify root causes of denials and variances.

• Excellent verbal and written communication skills, good judgment, tact, initiative, and resourcefulness.

• Knowledge and comprehension of Explanation of Benefits (EOB), contract language, and state and federal guidelines are required.

• Proficient in making precise arithmetic computations.

• Demonstrated ability to understand and interpret reasons for payments, refunds, or underpayments.

• Must be detail-oriented, organized, and capable of multitasking.

• Ability to foster supportive relationships with peers, clients, partners, and corporate executives.

• High level of skill in building relationships and delivering excellent customer service.

• Must be able to follow instructions and perform work independently according to department standards.

• Candidates will undergo a criminal background check and mandatory government exclusion check as a condition of employment or engagement.

🏝️ Benefits

• Criminal background check and government exclusion check as part of the application and hiring process.

• Remote work arrangement.