Outpatient Revenue Recovery Specialist

2 weeks ago

New Haven Connecticut, United States Yale New Haven Health Full time

Position Summary:


At Yale New Haven Health, we believe that every team member should embody our Vision, support our Mission, and uphold our Values. Our core values - integrity, patient-centered care, respect, accountability, and compassion - are essential in guiding our actions as professionals every day.


The Outpatient Revenue Recovery Specialist plays a crucial role in minimizing financial risks and reclaiming lost income associated with coding and medical necessity disputes.

This role encompasses a variety of responsibilities, including:

managing medical disputes through thorough analysis of clinical records, crafting persuasive arguments grounded in clinical evidence and payer policies, submitting appeals promptly, and identifying as well as addressing denial patterns to prevent potential revenue loss.

The Outpatient Revenue Recovery Specialist will also engage in audit-related compliance tasks and other administrative functions as necessary.

This position requires close collaboration with internal teams and managed care organizations to resolve issues and facilitate reimbursement for successful appeals.

EEO/AA/Disability/Veteran

Key Responsibilities:

  • Investigates payer disputes related to medical necessity, coding, and other factors leading to payment delays.
  • Assesses outpatient clinical disputes against medical documentation, encounter coding, payer policies, and coverage decisions to evaluate the potential for appeal.
  • Gathers supporting documentation by collaborating with internal departments and utilizing technology, drafting detailed and tailored appeal letters to payers in accordance with Medicare, Medicaid, Commercial, and YNHHS guidelines.
  • Monitors and tracks the receipt of appeals, ensuring timely follow-up on all submissions until a resolution is reached.
  • Identifies trends in payer disputes, triages discrepancies, and addresses ongoing issues related to medical necessity, coding, or services, collaborating or escalating as needed for resolution.
  • Work internally to create educational opportunities based on common themes identified through the appeal process to help prevent future disputes.
  • Maintain key denial metrics and performance data, developing and sustaining reports that highlight trends and action plans. Participate in organizational committees to present findings as required.
  • Engage directly with payers and coordinate meetings with contracting and payer representatives as necessary to support the appeals process.
  • Perform additional duties as assigned.

Qualifications:

EDUCATION
Completion of two (2) years of college or equivalent experience, with a solid understanding of medical terminology and anatomy. Familiarity with coding, billing, and the revenue cycle is essential. A working knowledge of human anatomy and physiology, disease processes, and demonstrated proficiency in medical terminology and medical records is required.

EXPERIENCE
A minimum of three to five years of experience in coding and/or billing is required. Prior experience with governmental and managed care denial and appeal processes, including familiarity with Recovery Audit Contractors (RAC), is essential. Knowledge of medical and insurance terminology, as well as CPT and ICD coding structures, is necessary; experience with billing forms (UB, Epic HB billing knowledge preferred) is advantageous.

LICENSURE


Certification as a Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCS-P) through the American Health Information Management Association (AHIMA), or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) through the American Academy of Professional Coders (AAPC) is required, or must be obtained within one year of hire.


SPECIAL SKILLS
Comprehensive knowledge of documentation elements within medical records is essential. Expertise in governmental payment policies and regulations, including medical necessity, National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), and Medically Unlikely Edits (MUE) policies and procedures is required.

The ability to analyze and resolve coding and medical necessity payer disputes through a deep understanding of payer policies and appeal processes is crucial. Previous experience with clinical disputes and appeals across all payers is preferred.

  • Clinical Denial Specialist

    5 days ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Job SummaryWe are seeking a highly skilled Clinical Denial Specialist to join our team at Yale New Haven Health. As a key member of our revenue recovery team, you will be responsible for reducing financial liability and recovering lost revenue for coding and medical necessity denials.Key ResponsibilitiesDenial Research and Analysis: Conduct thorough research...

  • Addiction Recovery Specialist

    2 weeks ago

    New Albany, Indiana, United States Avenues Recovery Full time

    About UsAvenues Recovery Center is a prominent network of rehabilitation facilities dedicated to addressing substance use disorders across multiple states. With a commitment to evidence-based practices and personalized care, we strive to redefine addiction treatment standards. Our comprehensive programs, including detoxification, residential care, partial...

  • Sanitation Specialist

    7 days ago

    New Haven, Connecticut, United States Avenues Recovery Full time

    About UsAvenues Recovery Center is a prominent network of rehabilitation facilities dedicated to helping individuals overcome substance use disorders. With numerous locations across various states, we provide tailored treatment in a welcoming and contemporary environment, covering all levels of care including detoxification, residential treatment, partial...

  • Peer Support Specialist

    3 months ago

    New Haven, United States Catholic Charities Full time

    Job DescriptionJob DescriptionPOSITION SUMMARY The Peer Recovery Support Worker supports integrated health and behavioral health care management for clients as a part of New Haven’s new CCBHC (Certified Community Behavioral Health Center) clinic. This role helps consumers with substance abuse and co-occurring disorders recognize that they are not alone and...

  • Recovery Support Specialist

    3 months ago

    New Haven, United States New Reach Full time

    Job DescriptionJob DescriptionCompany Overview:New Reach is undergoing an exciting transformation to bring the organization to its next level of success. Working toprovide shelter, housing, stabilization, and support for children, families, and individuals experiencing homelessnessacross CT since 1990, New Reach inspires independence for those affected by...

  • Revenue Recovery Coordinator

    5 days ago

    Rochester, New York, United States Paychex Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Recovery Representative to join our team at Paychex. As a Recovery Representative, you will be responsible for resolving bank returned items in a timely and accurate manner, while providing exceptional customer service to internal and external customers.Key ResponsibilitiesDevelop and maintain...

  • Medical Necessity Denial Specialist

    5 days ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Job SummaryWe are seeking a highly skilled Clinical Denial Specialist to join our team at Yale New Haven Health. As a key member of our revenue recovery team, you will play a critical role in reducing financial liability and recovering lost revenue for coding and medical necessity denials.Key ResponsibilitiesDenial Research and Analysis: Conduct thorough...

  • Outpatient Physical Therapy Specialist

    2 weeks ago

    New York, New York, United States Theradynamics-Outpatient Full time

    Position OverviewWe are seeking a dedicated Physical Therapist (PT) for a Full Time or Contractor role within our Outpatient facility.At Theradynamics, we take pride in being a leading provider of rehabilitative therapy services in the Tri-State area. With over 16 years of expertise, our mission is to support patients in achieving their goals through...

  • Vehicle Recovery Specialist

    1 week ago

    Grand Haven, Michigan, United States Tri-City Towing Service, LLC Full time

    Vehicle Recovery SpecialistTri-City Towing Service LLCA reputable family-operated towing business with extensive experience in the field is looking for a committed Vehicle Recovery Specialist to enhance their workforce.Position Overview:Efficiently operate both conventional wreckers and flatbed vehicles.Carefully manage the loading and unloading of...

  • Housekeeper - Residential Facility

    2 days ago

    New Haven, Connecticut, United States Avenues Recovery Full time

    About the RoleAvenues Recovery Center is seeking a highly skilled and detail-oriented Housekeeper to join our team at our residential facility in Fort Wayne. As a Housekeeper, you will play a vital role in maintaining the cleanliness and smooth operation of our facility, ensuring a comfortable and safe environment for our clients.Key ResponsibilitiesMaintain...

  • Sanitation Specialist

    2 weeks ago

    New Haven, Connecticut, United States Avenues Recovery Full time

    About UsAvenues Recovery Center is a prominent network of rehabilitation facilities dedicated to supporting individuals battling substance use disorders. With numerous locations across various states, we pride ourselves on delivering personalized care in a welcoming and modern environment. Our success stems from our dedicated team, combined with an...

  • Outpatient Medicine Specialist

    7 days ago

    New Haven, Connecticut, United States Cornell Scott-Hill Health Center Full time

    Cornell Scott-Hill Health Center - Outpatient Medicine SpecialistBecome a vital member of our team at Cornell Scott-Hill Health Center, where we are committed to enhancing the health and wellness of our patients. Our skilled group of healthcare professionals works collaboratively to assist patients in reaching their health objectives.Educational...

  • Patient Engagement Specialist

    2 weeks ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Overview:At Yale New Haven Health, we believe that every team member should embody our Vision, support our Mission, and uphold our Values. Our core values - integrity, patient-centered care, respect, accountability, and compassion - guide our actions as individuals and professionals every day.Under the supervision of the Guest Services Manager, the Patient...

  • Addiction Recovery Counselor

    1 week ago

    New Rochelle, New York, United States Lexington Center for Recovery, Inc Full time

    Join Our Team at Lexington Center for Recovery Lexington Center for Recovery is actively looking for dedicated Full-Time and Part-Time Addiction Recovery Counselors to join our team in providing essential support within our Substance Use Disorder clinic. Compensation: $45,000 - $65,000 annually, commensurate with licensure and prior...

  • Recovery Specialist

    2 months ago

    New York, United States Community Access Inc Full time

    Job DescriptionJob DescriptionFounded in 1974, Community Access celebrates its 50th Anniversary as a pioneer of supportive housing and social services in NYC for people with mental health concerns. We proudly lead advocacy efforts that rally our community to promote human rights, social justice, and economic opportunities for all. We are built upon the...

  • Clinical Revenue Management Specialist I

    2 days ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Job SummaryWe are seeking a highly skilled Clinical Revenue Management Specialist to join our team at Yale New Haven Health. The successful candidate will be responsible for performing a wide range of clinical revenue management activities to prevent insurer denials, enhance revenue, and recover payment for services that have been denied.Key...

  • Clinical Supervisor

    4 weeks ago

    New Haven, United States Avenues Recovery Full time

    Job DescriptionJob DescriptionWho We AreAvenues Recovery Center is a nationwide network of drug and alcohol rehab centers with ten locations across five states. With an unrivaled, evidence - based clinical curriculum and highly individualized care, Avenues continues to set new standards in the world of addiction treatment. Our programs - spanning detox,...

  • BHT - Behavioral Health Technician

    4 weeks ago

    New Haven, United States Avenues Recovery Full time

    Job DescriptionJob DescriptionWho We AreAvenues Recovery Center is a nationwide network of drug and alcohol rehab centers with ten locations across five states. With an unrivaled, evidence - based clinical program and highly individualized care, Avenues continues to set new standards in the world of addiction treatment. Our programs - spanning detox,...

  • Group Facilitator

    4 weeks ago

    New Haven, United States Avenues Recovery Full time

    Job DescriptionJob DescriptionWho We AreAvenues Recovery Center is a nationwide network of drug and alcohol rehab centers with fourteen locations across six states. With an unrivaled, evidence - based clinical curriculum and highly individualized care, Avenues continues to set new standards in the world of addiction treatment. Our programs - spanningdetox,...

  • BHT - Behavioral Health Technician

    4 weeks ago

    New Haven, United States Avenues Recovery Full time

    Job DescriptionJob DescriptionWho We AreAvenues Recovery Center is a nationwide network of drug and alcohol rehab centers with ten locations across five states. With an unrivaled, evidence - based clinical program and highly individualized care, Avenues continues to set new standards in the world of addiction treatment. Our programs - spanning detox,...