REVENUE RECOVERY SPECIALIST

Revenue Recovery Specialist

Definition and Role

Under the direction of the Assistant Director of Revenue Cycle – Revenue Recovery, the Revenue Recovery Specialist is responsible for monitoring billing & claims follow up on all claims and resolutions from participating insurance carriers and working proactively to collect from secondary insurance carriers.

Job Responsibilities and Duties

• Receive, open, and accurately deposit payments received via mail in accordance with established policies and procedures.
• Prepare, log, and maintain deposit slips and proofs of deposit received from clinics, ensuring completeness and accuracy.
• Follow up with clinics to obtain missing, incomplete, or incorrect documentation required for proper posting and reconciliation.
• Balance and reconcile the Clinic Reconciliation Sheet daily, investigating and resolving discrepancies in a timely manner.
• Process payments related to Medical Records requests in accordance with organizational and regulatory requirements.
• Complete adjustments for Medicaid claims in accordance with Max Allowed reimbursement guidelines and payer policies.
• Provide backfill support for Reception and Mail Processing functions as operational needs require.
• Assist with the printing of secondary claims, primary claims, and supporting medical records as needed to support timely billing and follow-up.
• Maintain compliance with internal controls, payer requirements, and confidentiality standards while performing all duties.
• Previous experience with eClinicalWorks.
• Knowledge of insurance Payers, EMR,Claims.

Qualifications

• Entry Level Position
• Demonstrated understanding of medical terminology, Insurance, EMR, & Claims required.
• Knowledge of patient confidentiality and HIPAA regulations.
• Knowledge of CPT, HCPCS, and ICD10 coding required.
• Knowledge of medical billing and collection practices.
• Understands Medicare and Medical Assistance regulations as they apply to job functions.
• Knowledge of working with electronic health records (EHR/EMR) or healthcare related computer systems.
• Establishes and demonstrates competency in accounts receivable systems & associated applications.
• Ability to communicate effectively with insurance carriers, patients, and co-workers.
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm.
• Excellent verbal and auditory skills are required for communicating with internal staff and representatives from external departments & agencies.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing this job the employee is frequently required to sit, talk, and listen.
2. The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
3. The employee must occasionally lift and/or move objects weighing up to 25 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust and focus.
5. Emotional/Psychological: Constant ability to make decisions and concentrate.