Impekkable/HealthTech is looking for a seasoned Hospital Revenue Recovery Specialist to join our team and support our managed hospitals.

100% Remote, Permanent, Full-time
Must have hospital complex claims and denials experience
ZERO micro-management – Must be able to work independently and stay on task

SUMMARY

This role is responsible for capturing reimbursement for hospital billed claims and denials that are a zero balance. The ideal candidate must have a minimum of 3 years of hospital insurance collections/claims/denials experience and possess a strong knowledge of Commercial, Third-Party Insurance Accounts, including but not limited to Medicaid, Managed Care, and Other Government payors. They must also have an in-depth understanding of payor contracts to include rules and guidelines governing payor collection activities and be able to “work” accounts in a computerized automated environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Researching and analyzing accounts for assigned clients and payers to diagnose reasons for underpayment/non-payment of claims that have gone to zero balance
• Evaluating appropriate actions needed for correcting the account.
• Maintaining track of all identified issues and errors.
• Identifying, reviewing, and interpreting third-party payments, adjustments, and denials.
• Facilitating first and second-level appeals to payers.
• Recommending changes to revenue collection based on analysis of recovery trends.
• Negotiating with third party payers to recover funds for grossly underpaid claims.
• Validate denial reason and ensure coding is accurate and reflects denial reasons for accounts that are under or partially paid and written of to a zero balance.
• Exhibit expertise in billing. Generating rebills and corrected claims for additional reimbursement.
• Responsible for correcting, completing, and processing claims for all payer codes where additional reimbursement is identified.
• Analyze and interpret that claims are accurately sent to insurance companies for additional reimbursement.
• Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts
• Process appeals online or via payer portal or fax.
• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsideration.
• Follow specific payor guidelines for appeal submission.
• Research contract terms/ interpretation and compile necessary supporting documentation for appeals and reconsiderations.
• Ensure proper account documentation, which is clear, concise, and includes all pertinent information.
• Understand and apply the terms of client’s contracts.
• Escalate immediate and appropriate payor trends and issues to management which impact cash, aging, and processes.
• Maintain or exceed 95% of established productivity goals and quality standards (30 to 50 accounts).
• Utilize company software in all account follow-up activities and promote working toward paperless environment.
• Ensure professional verbal and written communication with facilities, clients, and co-workers following established guidelines.
• Obtain management approval when necessary to communicate with external clients about internal processes and procedures.
• Follow and maintain patient, account, and client confidentiality always.
• Adhere to HIPAA and Compliance Policy Guidelines.
• Follow timekeeping and attendance policy daily.

OTHER DUTIES AND RESPONSIBILITIES

• Perform other duties as assigned.
• Provide leadership to others through example and sharing of knowledge and skill.
• Comply with all company policies and procedures, including the corporate compliance program.
• Actively promote HealthTech/Impekkable in all interactions with customers.
• Act in accordance with company stated values – integrity, initiative, respect, personal commitment, excellent performance, and customer satisfaction.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS

• High school diploma or GED required.
• Must have hospital complex claims and denials experience
• Knowledge of Commercial, Third-Party Insurance Accounts including but not limited to Medicaid, Managed Care, and Other Government Rules and Guidelines governing collection activities.

COMPUTER OPERATIONS

• Previous experience should include basic computer knowledge.
• Knowledge of Microsoft Word and Excel required.
• Working accounts in a computerized automated environment.

OTHER SKILLS AND ABILITIES

• Use independent and critical thinking skills to achieve assigned objectives.
• Able to organize and prioritize.
• Attention to detail.
• Must be accurate and timely.
• Good decision-making skills required.
• Able to maintain confidential information.