Remote Revenue Recovery Pro
Currance, Irvine, CA, United States
Description
We’re looking for great talent from and can accept applicants living in: AR, AZ, CA, CO, CT, FL, GA, IA, IL, MN, MO, NC, NJ, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI
Job Overview
The Revenue Recovery Specialist investigates and analyzes accounts to properly identify denials, resolve outstanding balances by submitting appeals, identify insurance underpayments, determining root cause of underpayments, engage insurance and hospital staff, and take necessary action to recover insurance denials and underpayments for patient billing. Description
This is a remote position.
We’re looking for great talent from and can accept applicants living in: AR, AZ, CA, CO, CT, FL, GA, IA, IL, MN, MO, NC, NJ, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI
Job Overview
The Revenue Recovery Specialist investigates and analyzes accounts to properly identify denials, resolve outstanding balances by submitting appeals, identify insurance underpayments, determining root cause of underpayments, engage insurance and hospital staff, and take necessary action to recover insurance denials and underpayments for patient billing.
Job Duties & Responsibilities
Identify and resolve a minimum of 25-30 accounts per day that have been improperly denied or underpaid by insurance carriers for administrative reasons. This includes researching denied claims, collaborating with team members, processing appeals, resolving the denial for appropriate payment, and identifying variance underpayments. Identify insurance underpayments and denials for hospital patient accounts; identification of variance underpayments and denials will include zero payments, full denials, line-item denials, billing corrections, updated billing code requirements and incorrect payor system setup. Monitor denial and appeals information for payor, provider, or departmental denial and variance trends. Routinely reports to management regarding trends and recommends process improvement initiatives. Regularly reviews aging appeals and problem cases. Verify insurance payment for accuracy and compliance with contract terms and fee schedules. Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve
payment variances; work efforts are to be focused on identification and recovery of high dollar insurance underpayments to increase reimbursements for the hospital.
Review claims billed and insurance remits to research denials and variances; claim review may include coding, billing, and discrepancies with patients’ insurance information. Collaborate with the facilities to send corrected claims and appeals. Notate variance or denial reason within patient accounts and update patient accounts utilizing pre-defined reason codes. Contact insurance providers regarding identified denials and underpayments. Follow insurance payor guidelines to collect additional reimbursement on behalf of the facility. Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution is determined. Assist, as assigned, with follow-up on customer patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill claim to patient’s insurance, proration to correct financial class and notate patient accounts with steps taken to resolution. Establish relationships and maintain open communication with third party payor representatives to resolve claims issues. Complete projects assigned to improve operations within the team and to increase reimbursements for facilities. Perform other duties as assigned.
Requirements
Position Requirements & Qualifications
High School or equivalency diploma required. 3 to 5 years or more experience, where the primary function was Hospital Billing, Insurance follow-up, Denial resolution, or similar work, 3 of which must have been in a hospital patient accounts department or equivalent. Customer Service oriented. Proficiency with computers including Microsoft Office Suite/Teams and GoToMeeting/Zoom, etc.
Knowledge, Skills & Abilities
Knowledge of computer applications or other automated systems, such as excel spreadsheets, word, email, and data base software in working assignments. Intermediate knowledge of hospital billing, revenue cycle and medical terminology. Intermediate knowledge of revenue cycle processes affecting reimbursement including intake, admissions, registration, billing, accounts receivable, denials, account follow up, cash posting, payor logs and aging AR management. Intermediate knowledge of CPT, HCPCS, and ICD-10 coding required. Utilize critical thinking skills to resolve aged and problematic accounts. Ability to navigate healthcare information system(s) and Clearinghouse(s) to identify root causes of denials and variances. Display excellent verbal and written communication, good judgement, tact, initiative, and resourcefulness. Knowledge and understanding of Explanation of Benefits (EOB), contract language, state, and federal guidelines required. Skilled in making accurate arithmetic computations. Proven ability to understand and interpret reason for payments, refunds, or underpayments. Must be detail oriented, organized, and ability to multi-task. Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives. High level of skill building relationships and providing excellent customer service. Must be able to follow directions and to perform work according to department standards independently.
Disclosure Statement
As part of the Currance application and hiring experience, all candidates are subject to a criminal background check and a government exclusion check. The government exclusion check is a mandatory screening process that verifies whether an individual is listed on federal or state exclusion or watchlists, including but not limited to, the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM.gov).
These screenings are conducted to ensure compliance with applicable federal and state laws and regulations, to protect the integrity of federally funded programs, the clients we support, and to prevent participation by individuals who are excluded due to fraud, abuse, or other misconduct. By submitting an application, candidates acknowledge and consent to these checks as a condition of employment or engagement.
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We’re looking for great talent from and can accept applicants living in: AR, AZ, CA, CO, CT, FL, GA, IA, IL, MN, MO, NC, NJ, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI
Job Overview
The Revenue Recovery Specialist investigates and analyzes accounts to properly identify denials, resolve outstanding balances by submitting appeals, identify insurance underpayments, determining root cause of underpayments, engage insurance and hospital staff, and take necessary action to recover insurance denials and underpayments for patient billing. Description
This is a remote position.
We’re looking for great talent from and can accept applicants living in: AR, AZ, CA, CO, CT, FL, GA, IA, IL, MN, MO, NC, NJ, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI
Job Overview
The Revenue Recovery Specialist investigates and analyzes accounts to properly identify denials, resolve outstanding balances by submitting appeals, identify insurance underpayments, determining root cause of underpayments, engage insurance and hospital staff, and take necessary action to recover insurance denials and underpayments for patient billing.
Job Duties & Responsibilities
Identify and resolve a minimum of 25-30 accounts per day that have been improperly denied or underpaid by insurance carriers for administrative reasons. This includes researching denied claims, collaborating with team members, processing appeals, resolving the denial for appropriate payment, and identifying variance underpayments. Identify insurance underpayments and denials for hospital patient accounts; identification of variance underpayments and denials will include zero payments, full denials, line-item denials, billing corrections, updated billing code requirements and incorrect payor system setup. Monitor denial and appeals information for payor, provider, or departmental denial and variance trends. Routinely reports to management regarding trends and recommends process improvement initiatives. Regularly reviews aging appeals and problem cases. Verify insurance payment for accuracy and compliance with contract terms and fee schedules. Identify root cause of insurance reimbursement underpayments and take appropriate actions to resolve
payment variances; work efforts are to be focused on identification and recovery of high dollar insurance underpayments to increase reimbursements for the hospital.
Review claims billed and insurance remits to research denials and variances; claim review may include coding, billing, and discrepancies with patients’ insurance information. Collaborate with the facilities to send corrected claims and appeals. Notate variance or denial reason within patient accounts and update patient accounts utilizing pre-defined reason codes. Contact insurance providers regarding identified denials and underpayments. Follow insurance payor guidelines to collect additional reimbursement on behalf of the facility. Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution is determined. Assist, as assigned, with follow-up on customer patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill claim to patient’s insurance, proration to correct financial class and notate patient accounts with steps taken to resolution. Establish relationships and maintain open communication with third party payor representatives to resolve claims issues. Complete projects assigned to improve operations within the team and to increase reimbursements for facilities. Perform other duties as assigned.
Requirements
Position Requirements & Qualifications
High School or equivalency diploma required. 3 to 5 years or more experience, where the primary function was Hospital Billing, Insurance follow-up, Denial resolution, or similar work, 3 of which must have been in a hospital patient accounts department or equivalent. Customer Service oriented. Proficiency with computers including Microsoft Office Suite/Teams and GoToMeeting/Zoom, etc.
Knowledge, Skills & Abilities
Knowledge of computer applications or other automated systems, such as excel spreadsheets, word, email, and data base software in working assignments. Intermediate knowledge of hospital billing, revenue cycle and medical terminology. Intermediate knowledge of revenue cycle processes affecting reimbursement including intake, admissions, registration, billing, accounts receivable, denials, account follow up, cash posting, payor logs and aging AR management. Intermediate knowledge of CPT, HCPCS, and ICD-10 coding required. Utilize critical thinking skills to resolve aged and problematic accounts. Ability to navigate healthcare information system(s) and Clearinghouse(s) to identify root causes of denials and variances. Display excellent verbal and written communication, good judgement, tact, initiative, and resourcefulness. Knowledge and understanding of Explanation of Benefits (EOB), contract language, state, and federal guidelines required. Skilled in making accurate arithmetic computations. Proven ability to understand and interpret reason for payments, refunds, or underpayments. Must be detail oriented, organized, and ability to multi-task. Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives. High level of skill building relationships and providing excellent customer service. Must be able to follow directions and to perform work according to department standards independently.
Disclosure Statement
As part of the Currance application and hiring experience, all candidates are subject to a criminal background check and a government exclusion check. The government exclusion check is a mandatory screening process that verifies whether an individual is listed on federal or state exclusion or watchlists, including but not limited to, the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM.gov).
These screenings are conducted to ensure compliance with applicable federal and state laws and regulations, to protect the integrity of federally funded programs, the clients we support, and to prevent participation by individuals who are excluded due to fraud, abuse, or other misconduct. By submitting an application, candidates acknowledge and consent to these checks as a condition of employment or engagement.
#J-18808-Ljbffr