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Revenue Recovery Professional

2 months ago

Oak Brook, Illinois, United States Advocate Health Full time
Job Summary

We are seeking a highly skilled Revenue Recovery PB Follow Up Representative to join our team at Advocate Health. As a key member of our revenue cycle team, you will play a critical role in ensuring the timely and accurate resolution of denied claims.

Key Responsibilities
  • Conduct thorough research and analysis of denied claims to identify compliance issues and determine the appropriateness of appeals.
  • Secure necessary medical documentation to support the appeal process and collaborate with staff as needed to resolve issues related to denials.
  • Review and analyze accounts to determine the need for technical appeals based on medical necessity and prepare appeal letters accordingly.
  • Prioritize appeals according to filing limitations established by payor contracts and maintain ongoing documentation of denial status in denial software.
  • Identify and analyze payor trends and communicate findings to leadership to inform revenue growth opportunities.
  • Meet regularly with the Denial Prevention Advisor to review trends in denial categories and provide feedback for process improvements.
  • Manage a caseload and monitor day-to-day compliance with appeal decision time frames.
Requirements
  • Bachelor's Degree in Finance or a related field, or equivalent knowledge.
  • Typically requires 3 years of experience in Hospital billing, finance, medical necessity denials management, coding, or a related field.
  • Excellent critical thinking and analytical skills, with a high attention to detail.
  • Ability to meet deadlines in a fast-paced environment and work collaboratively with others.
  • Strong computer skills, including high proficiency with Microsoft Office Suite.
Working Conditions

This role operates in a normal office environment and requires the ability to operate all necessary equipment.