Hospital Revenue Recovery Specialist
1 week ago
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.
- 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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