Specialist, Revenue Recovery

4 weeks ago

Brentwood, California, United States Ovation Healthcare Full time

DUTIES AND RESPONSIBILITIES:

  • Denial and Underpayment Analysis:

    • Utilize the Health Innovas "Pulse" platform to systematically review client accounts flagged for potential denials or underpayments.

    • Conduct deep-dive investigations into technical denials, including those related to eligibility, registration errors, missing authorizations, and other administrative issues.

    • Analyze explanation of benefits (EOBs) and compare actual payments against modeled payer contracts to precisely identify and quantify contractual underpayments.

  • Resolution and Recovery:

    • Correct data errors and resubmit claims in a timely manner to resolve technical denials.

    • Prepare detailed documentation and justification to support underpayment appeals and resolution efforts.

    • Collaborate with Clinical Appeals Specialists (RNs) and Certified Coders by gathering necessary documentation for complex clinical and coding-related denials.

  • Process Improvement and Reporting:

    • Diagnose the root cause of each denial and underpayment to identify trends by payer, service line, and denial reason.

    • Meticulously document all actions, findings, and communications within the Pulse platform to ensure a clear audit trail and support team collaboration.

    • Contribute to performance reports that provide actionable insights to both internal leadership and clients, helping to prevent future revenue leakage.

  • Team Collaboration:

    • Serve as a key resource for resolving complex payment issues, working alongside Payer Contract Specialists and Denial Management leadership.

    • Participate in ongoing training to master the Pulse platform and stay current on evolving payer rules and denial trends.

KNOWLEDGE, SKILLS, AND ABILITIES:

  • Strong foundational understanding of the healthcare revenue cycle, including claims submission, remittance processing, and follow-up.

  • Demonstrated analytical and critical thinking skills with a high level of attention to detail.

  • Excellent written and verbal communication skills, with the ability to clearly and concisely document account activity.

  • Proficient with computers and technology, with an aptitude for quickly learning and mastering new software platforms.

  • Prior experience specifically in denial analysis or underpayment identification.

  • Familiarity with reading and interpreting payer contracts and fee schedules.

  • Experience working within various payer portals and systems.

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:

High School Diploma or equivalent required, Associate's or Bachelor's degree in a related field preferred.

Minimum of 2+ years of experience in healthcare accounts receivable (AR), hospital billing, or revenue cycle resolution.

Experience working within various payer portals and systems.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

  • 100% Remote

  • Reliable high-speed internet connection is required for all remote/hybrid positions.

  • Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.

  • A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.

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