Denials Recovery Analyst
Summary
Review hospital claims and insurance contracts to identify underpayments, appeal denials, and recover revenue for healthcare providers using medical coding knowledge and analytical skills.
At Revecore, our work helps hospitals recover the revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, we combine specialized expertise with proprietary technology to solve problems others can't. Just as importantly, we've built a workplace where people support one another, embrace innovation, and are trusted to do their best work.
Work that matters. People who care. Empowered to deliver results.
Why Work Here
Work That Matters - Help hospitals and communities by solving problems that make a real difference.
People Who Care - Work alongside teammates who support each other and our clients.
Room to Grow - Grow your career through learning, development, and internal opportunities.
Empowered to Deliver - Take ownership, use innovative technology, and do your best work.
Benefits That Support You - Comprehensive health coverage, 401(k) match, paid training, generous PTO, paid holidays, and more.
Denial Recovery Analyst
Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Apply now and become an integral part of our mission to deliver efficient, accurate, and compassionate healthcare payment solutions!
Responsibilities
Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims
Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
Review insurance contracts to gain thorough understanding of payment methodologies
Contact insurance companies to obtain missing information, explain and resolve denials and arrange for payment or adjustment processing on behalf of client
Follow up on claims in a timely fashion as outlined in Revecore and/or departmental policies and procedures
Document information within appropriate Revecore and client systems
Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel
Communicate with client contact concerning all issues related to billing, posting, contracts and all other client related issues, both in an informal manner through daily contact and formal manner through scheduled meetings
Promotes positive public relations for Revecore, including maintaining a professional attitude and approach with all payors
Build strong, lasting relationships with clients, payors and Revecore personnel
Support and direct claims to all Revecore departments and client onsite analysts
Attend client, department and company meetings
Comply with federal and state laws, company policies and procedures
You will be successful if you have
Working knowledge of Microsoft Office suite (Word, Excel)
Moderate computer proficiency
Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
Ability to write routine correspondence (in English)
Ability to define problems, collect data, establish facts and draw valid conclusions
Strong customer service orientation
Excellent interpersonal and communication skills
Commitment to company values
Qualifications
Minimum 2 years of insurance billing, denial management and/or utilization review experience:
Experience reviewing and analyzing hospital claims
Knowledge of healthcare codes including CPT, ICD-9, ICD-10, HCPC, DRG, and ability to correctly use and apply codes in operational setting
High school diploma or equivalent
Work at Home Requirements:
A quiet, distraction-free environment to work from in your home.
A reliable hard-wired private internet connection that is not supplied via cellular data or hotspot is required.
Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
The workspace area accommodates all workstation equipment, related materials, and provides adequate surface area to be productive.
Must reside in the United States within one of the states listed below:
Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts Michigan, Minnesota, Mississippi Missouri, Nebraska, New Hampshire North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin
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Revecore is an Affirmative Action/Equal Opportunity Employer committed to providing equal employment opportunities for all applicants and employees. We make employment decisions without regard to any characteristic protected by applicable law and encourage individuals of all backgrounds to apply.
Employment is contingent upon eligibility to work in the United States, verification of employment history, and successful completion of a background check.