Revenue Recovery Specialist I-Patient Accounting

About the role

Analyzes and performs validation of claims payment against payer contract terms to ensure payer compliance. Requires detailed knowledge of contractual agreements, contract interpretation, reimbursement methodologies and configuration. Will work to identify payer specific trends and reports significant and recurring issues to the Revenue Recovery Specialist II and the Revenue Recovery Supervisor. Type of Opportunity: Full time Job Exempt: No Job is based: Remote Workers New Mexico Work Shift: Days (United States of America)

Responsibilities

• Primarily responsible for working in the payment variance work queue to identify payer specific trends and reports significant and recurring issues to the Revenue Recovery Specialist II.
• Will work, as needed, on validation reports and report any recommendations on any configuration changes that need to be made to the Revenue Recovery Specialist II
• Must maintain and apply knowledge of complex hospital specific reimbursement methodologies.
• Must be a resource for hospital 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.
• Must report payer issues up to the Revenue Recovery Supervisor on payer compliance issues.
• Performs other related tasks and projects as assigned

Requirements

• One to two years experience in a Hospital or Physician medical claims processing, insurance billing or insurance collections environment. Requires knowledge of Third Party Reimbursement and Contracts.
• 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.
• Must also possess organizational skills, the ability to analyze reports and interpret various reimbursement models.
• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Wellness
• Why work at Presbyterian?
• As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
• About Presbyterian Healthcare Services
• Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
• AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
• We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

Benefits

Additional Information

Location Address: Remote Office Santa Fe, NM 87501 Compensation Pay Range: Minimum Offer $17.46 Maximum Offer $25.96 Now Hiring: Revenue Recovery Specialist I-Patient Accounting

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