Revenue Recovery Specialist II - Patient Accounting
US-NM-Albuquerque
Careers (External)
Req #: 48380
Type: Full Time
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Overview: Presbyterian is seeking a Revenue Recovery Specialist II for Patient Accounting to validate, analyze and quantify identified payment variances. Organizes and submits an in-depth payer appeal package to the Supervisor of Revenue Recovery, which outlines all payments that have been assigned as a discrepancy to contracted terms. Requires extensive knowledge of contractual agreements, contract interpretation, reimbursement methodologies and configuration. Will serve as a subject matter expert for all reimbursement issues including maintenance of all fee schedules. Will be the lead in the validation process of the contract load in our contract compliance software. Will act as a liaison for the Revenue Recovery Supervisor when taking corrective action against the payers How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us * Full Time - Exempt: No * Job is based at Rev Hugh Cooper Admin Center * Work hours: Days * Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Responsibilities: * Primarily responsible to validate, analyze and quantify identified payer specific trends provided by Revenue Recovery Specialist I * Must report validated payer specific trends up to Revenue Recovery Supervisor for payer intervention * Will take part in reporting variances to our various payers including running reports on variances as a result of their contract load issues. * Ability to lead and facilitate work going out to Revenue Recovery Specialist I * Primarily responsible to review, test and validate the contract load in contract compliance software. * Will run validation reports and make recommendations on any configuration changes that need to be made. * Will work with various other departments to ensure changes are made and again validate for accuracy. * Maintain and apply knowledge of complex reimbursement methodologies. * Must be a resource for follow up and denial teams to answer reimbursement related questions. * Demonstrates excellent analytical, problem solving, investigative and research ability during the configuration of contracts and fee schedules and throughout the validation process. * Performs other related tasks and projects as assigned Qualifications: * Three (3) to five (5) years experience in a Hospital or Physician medical claims processing, insurance billing or insurance collections environment. * Must have working knowledge of reimbursement methodologies i.e. DRGs, OPPS fee schedule, Medicare APCs, multiple surgical rules etc. Must possess organizational skills, the ability to analyze reports and work within our contract compliance system. * Needs to be very detail orientated and have a thorough understanding of the life cycle of an insurance claim including being able to interpret payer 835 data. * Must demonstrate strong analytical skills, strong interpersonal skills, and the ability to interface with various departments within the revenue cycle. Education Essential: High School Diploma or GED
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