Hospital Revenue Recovery Specialist

1 week ago


Dallas, Texas, United States United Surgical Partners International Inc (USPI) Full time
Job Summary

United Surgical Partners International Inc (USPI) is seeking a highly skilled Revenue Cycle Specialist to join our team. As a key member of our revenue recovery team, you will be responsible for resolving outstanding surgical claims and ensuring maximum reimbursement for our facilities.

Key Responsibilities
  • Claim Resolution: Timely follow-up and resolution on all outstanding A/R, including unpaid, underpaid, and denied claims for all payers, including self-pay, to obtain maximum reimbursement.
  • Work Queue Management: Manage daily work queue to prioritize high-dollar claim balances and ensure timely resolution.
  • Insurance Follow-up: Perform insurance claim follow-ups for insurance denials and appeals, and contact insurance companies to check eligibility and benefits.
  • Payer Contract Review: Review payers' contracts to ensure claims have processed correctly and identify opportunities for improvement.
  • Medical Necessity Appeals: Prepare and write medical necessity appeals when appropriate, and provide requested medical documentation.
  • Patient Balance Review: Review patient balances to ensure accuracy and follow up with patients to obtain payments.
  • Insurance Payment Review: Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
  • Claim Resolution Strategies: Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCDs) for claim resolution, and negotiate payment amounts for procedures with third-party administrators.
  • Refund and Adjustment Recommendations: Recommend adjustments when applicable or recommend refunds for overpayments to insurance carriers or patients, providing the appropriate documentation.
Requirements
  • 3+ years of hospital collections experience preferred.
  • Excellent communication and interpersonal skills.
  • Skilled in time management and prioritization of emergent situations.
  • Excellent customer service skills, demonstrating professionalism.
  • Ability to read and interpret insurance explanations of benefits and managed care contracts.
  • Knowledge or experience working with a variety of health care insurance payers is preferred.
  • Intermediate computer proficiency in Microsoft Office, including Excel and Outlook.
  • DDE, Ability Ease, nThrive, Cerner, Advantx, Vision, HST, Waystar experience preferred.
  • High School Diploma or equivalent.


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