Revenue Recovery Specialist

4 weeks ago

Dayton, Ohio, United States Providence Medical Grp. Full time
Job Title: Revenue Recovery Specialist

Providence Medical Grp. is seeking a skilled Revenue Recovery Specialist to join our team. The successful candidate will be responsible for ensuring timely and accurate follow-up activity to maintain a high quality of service, resolution of claims, and timely payments.

Key Responsibilities:

  • Maintain open lines of communication between Revenue Recovery Team and Practices.
  • Monitor performance and alert the Revenue and CDI Supervisor of concerns.
  • Monitor and report on Standard Reports in Athena.
  • Accept payments from patients on their accounts for Self-Pay balances.
  • Monitor alarms and call the carriers.
  • Responsible for filing appeals in a timely manner.
  • Responsible for sending chart notes.
  • Responds to practice requests for claims help via the Athena Board, Email, Telephone, and Fax.
  • Corrects and resubmits claims with proper CPT, HCPCS, and ICD-10 coding.
  • Investigates and appeals denied claims to insurance companies.
  • Redrops Insurance Claims as needed.
  • Drops patient responsible balances to patient.
  • Corrects patient demographics, insurance IDs, and insurance packages, as needed.
  • Under supervision of the Revenue and CDI Supervisor, adjusts global, contractual, small balances, bankruptcies, Charity Care, past filing limits.
  • Merge duplicate patient accounts.
  • Separates patient accounts, (two patients, same name, wrong patient billed, etc.).
  • Advises and communicates to practice personnel regarding proper CPT, HCPCS, and ICD-10 codes.
  • Advises practice personnel in finding correct insurance package in the system and ID number formats for clean claims submission.
  • Responsible for working claims in the CBOHOLD and FOLLOWUP buckets.
  • Calling insurance companies to follow-up on unpaid claims 30-days and older.
  • Identifies trends in the way carriers are adjudicating claims, researches the trend, and reports to the Revenue and CDI Supervisor.
  • Identifies possible problems with EDI (electronic date interchange) transmissions from Athena to Clearinghouse to Carrier and reports problems/trends to Athena and alerts Revenue and CDI Supervisor who will collaborate with the Credentialing Coordinator.
  • Identifies carrier problems with incorrect provider ID numbers and reports to the Credentialing Coordinator and alerts the Revenue and CDI Supervisor.
  • Participates in educational activities such as insurance seminars, Athena, or billing entity updates and releases.
  • Remain current with carrier rules, such as claims filing deadlines, bundling, globals.
  • Review monthly Payment Mismatch Tracker and report discrepancies to Revenue and CDI Supervisor.
  • Run Zero Pay report weekly for follow-up and report at the monthly Revenue Recovery Team meeting.
  • Act as liaison with Operations Manager.
  • Manage unpostables as assigned.
  • Maintains working relationship with third party payers and works toward resolving conflicts that may arise.
  • Assist practice site supervisor(s) with MGRHOLD issues as needed.
  • Maintains confidentiality.
  • Attends all meetings as requested.
  • Performs special projects as assigned to resolve recovery issues, settlements with payers, and optimize recovering revenue.
  • Performs other duties as assigned for the purpose of facilitating the needs of the job.

Requirements:

  • High school diploma or GED equivalent.
  • Minimum of two years medical office billing/coder experience.
  • A medical billing certificate or degree may be considered in lieu of experience.

Knowledge / Skills / Abilities:

  • Knowledge of medical terminology, anatomy, physiology, medical law, and ethics.
  • Knowledge of CPT, HCPCS, and ICD-10 coding rules and application.
  • Knowledge of various computer applications (ex. Microsoft Word and Excel).
  • Knowledge of AthenaHealth billing software helpful, but not required.
  • Knowledge of HIPAA as it pertains to patient records and company procedures.
  • Skills in using fundamental math skills, computer applications, and keyboarding.
  • Skills in processing information accurately.
  • Skills in problem solving and the ability to pay attention to detail.
  • Skills in decision making and problem solving.
  • Skills in effective verbal and written communications.
  • Skills in effective time management.
  • Ability to establish and maintain effective relationships with staff at all levels.
  • Ability to handle sensitive and confidential patient information in a professional manner.
  • Ability to work independently.
  • Ability to prioritize work and is detail oriented.
  • Ability to maintain HIPAA Compliance regulations.

Environment/Physical Working Conditions:

  • Office setting. Minimal exposure to communicable diseases.
  • Must be able to sit 6 to 8 hours daily, using a computer terminal. Occasional need to lift 25 pounds.
  • Requires hand eye coordination.
  • Occasional stress during deadline periods.

Benefits:

  • Medical
  • Dental
  • Vision
  • STD,LTD, Life and AD&D
  • 401(k)

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