Revenue Recovery Specialist

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

📋 Description

• Use the Health Innovas "Pulse" platform to assess client accounts that have been flagged for possible denials or underpayments.

• Examine technical denials related to eligibility, registration mistakes, missing authorizations, and administrative concerns.

• Evaluate EOBs and contrast actual payments with modeled payer contracts to pinpoint and quantify contractual underpayments.

• Rectify data inaccuracies and resubmit claims to address technical denials.

• Create documentation and justification for underpayment appeals and resolution initiatives.

• Collect documentation for intricate clinical and coding-related denials in partnership with Clinical Appeals Specialists and Certified Coders.

• Identify root causes of denials and underpayments, recognizing trends by payer, service line, and reason for denial.

• Record actions, findings, and communications within the Pulse platform.

• Assist in the preparation of performance reports for internal leadership and clients.

• Collaborate with Payer Contract Specialists and Denial Management leadership to navigate complex payment challenges.

• Engage in ongoing training regarding the Pulse platform, payer regulations, and denial trends.

⛳️ Requirements

• High School Diploma or equivalent is mandatory.

• An Associate's or Bachelor's degree in a relevant field is preferred.

• At least 2+ years of experience in healthcare accounts receivable (AR), hospital billing, or revenue cycle resolution is required.

• Strong foundational knowledge of the healthcare revenue cycle, encompassing claims submission, remittance processing, and follow-up.

• Proven analytical and critical thinking abilities with a keen eye for detail.

• Exceptional written and verbal communication skills.

• Proficient with computers and technology, demonstrating a quick ability to learn and master new software platforms.

• Prior experience specifically in denial analysis or underpayment identification.

• Familiarity with interpreting payer contracts and fee schedules.

• Experience navigating various payer portals and systems.

• A reliable high-speed internet connection is necessary.

• A stable Wi-Fi connection with adequate bandwidth to support video conferencing, cloud-based tools, and other online work-related tasks.

• A HIPAA-compliant secure workspace that is free from unauthorized access or interruptions.

• No use of public Wi-Fi unless connected through a secure company-provided VPN.

• Adherence to applicable HIPAA privacy and security regulations.

🏝️ Benefits

• 100% Remote work opportunity.

• Reliable high-speed internet connection is required for remote/hybrid roles.

• HIPAA-compliant work environment.

• Career development opportunity to become a subject matter expert.

• Ongoing training to master the Pulse platform and remain updated on payer rules and denial trends.

• A collegial atmosphere that promotes professionalism and teamwork.

• Opportunity to collaborate with highly skilled subject matter specialists and operations executives.