Revenue Recovery Reconciliation Specialist

4 weeks ago

Fairfax Station, United States North American Partners In Anesthesia Full time

Fairfax,VA - USA

Position Requirements

The Revenue Recovery Reconciliation Specialist is responsible for managing and analyzing Audit Tracking Reports to compare total of cases billed with the amount of anesthesia cases performed by our providers at each site. This position requires the ability to work independently and to handle multiple assignments in an efficient matter. The Revenue Recovery Reconciliation Specialist will post any missed cases found during Revenue Recovery Audit processes to capture possible missed revenue and report missed batches using a set of scenarios to quantify, identify and track issue trends to report the findings, identify areas in the RCM workflows where we can improve the processes in place and decrease the occurrences.

Under the Direct supervision of the Supervisor, Revenue Recovery Reconciliation and Manager, Revenue Recovery reconciliation, the Specialist is responsible for performing a detailed review prior to correcting any charges assigned to the team for correction. This position requires a full understanding of payer claim processing. This position will work closely with Revenue Recovery auditors to complete and submit correction timely per payer policies and following Napa Workflows and Revenue Recovery set rules. This position requires the ability to work independently and to handle multiple assignments in an efficient matter.

ACTIVITY / RESPONSIBILITY

  • Perform correction in billing system making sure all the claim corrections submitted are following the respective payer requirements.
  • Perform a pre-correction review before working any charge corrections identified by the Revenue Recovery Audits to ensure the submission of the correction is accurate and follow payer guidelines and Revenue recovery set of rules to avoid risking the revenue collected.
  • Research payer requirements to ensure we are following payer guidelines by Billing area/state while working charge corrections.
  • Obtain, manage, and analyze Audit Tracking Report to identify missing anesthesia cases that have not been captured within the billing system and might result in lost revenue.
  • Identify trends and report findings, actions, and status to Supervisor and Manager of Revenue Recovery Reconciliation.
  • Register patients in billing systems, post charges, and submit insurance claims to insurance companies following Napa workflows and payer guidelines.
  • Retrieve Medical record from EMR and ensure they are uploaded to the different platforms and are available for review by other departments.
  • Navigate through and review medical records.
  • Verify patients' insurance benefit eligibility and coverage prior to posting to ensure claim is submitted to correct payer and avoid denials.
  • Perform a pre-posting review before working any missed cases reported by the auditors.
  • Post any missed cases found during the Audit tracking process or identified by the auditors during the Revenue Recovery audits.
  • Complete logs, reports, and forms to properly document findings for reporting purposes.
  • Properly document actions taken to resolve issues.
  • Assist and cross train as business needs dictate and during critical times.
  • Assist Supervisor/Manager with special project and other task as needed
REQUIRED QUALIFICATIONS :
  • High school diploma or equivalent certification required.
  • Minimum 3 year of Medical Billing experience
  • Knowledge of payer policies, HIPAA Compliance, and A/R experience required.
  • Experience with Microsoft365, Excel and Word required.
  • Knowledge working and editing PDF files.
  • Ability to multi-task, prioritize, with a strong emphasis on attention to detail.
  • Must be capable of working independently, but effectively as an integral part of the team.
  • Dependable in both production and attendance.
  • Exceptional organization and time management skills.
  • Communicate interdepartmentally, both verbally and in written text.
  • Strong data entry skills.
  • Document management systems experience and Microsoft365 (Excel experience required).
DESIRED/PREFERRED QUALIFICATIONS :
  • Coding Certification preferred.
  • Associate degree preferred.
  • Experience with medical billing software (GE Group Management, Medsuite and Athena preferred), document management systems.
  • Knowledge of basic patient accounting processes and healthcare terminology strongly preferred.


This is a virtual position however the ideal candidate will be within the Fairfax, VA area.

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.

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