Denials Recovery Analyst

Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further.

Revecore Perks:

• We offer paid training and incentive plans
• Our medical, dental, vision, and life insurance benefits are available from the first day of employment
• We enjoy excellent work/life balance
• Our Employee Resource Groups build community and foster a culture of belonging and inclusion
• We match 401(k) contributions
• We offer career growth opportunities
• We celebrate 12 paid holidays and generous paid time off  

Location: Remote -- USA

The Role: 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!

As a Denial Recovery Analyst, you will:

• 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 company 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 in 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
• All other duties as assigned

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

Education and Experience Requirements:

• 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.

Revecore is an equal opportunity employer that does not discriminate on the basis of race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status.

We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply.

Must reside in the United States within one of the states listed below:

Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia.

Originally posted on Himalayas