Job Title: Recovery Specialist
Shift/Schedule: Local candidates only; 8-4:30 -- (Hybrid role), 2-3 days required onsite
JOB SUMMARY:
The Recovery Specialist is responsible for the efficient use of a variety of internal Revenue Cycle systems and performs tasks for
claims processing, registration and billing edits, claim edits and payer rejections. Follows up on unpaid claims to collect money
due. Researches, appeals and resolves denials and payment variances with the goal of challenging and overturning denials and
maximizing collections. Maintains patient financial records and efficiently documents account notes. Performs Intake functions
and activities as requested. Achieves established KPI goals for Revenue Cycle. Is flexible, multitasks, and performs a variety of
duties as requested by Management.
JOB REQUIREMENTS:
* HS/GED
* 1-3+ years of relevant billing experience
* Ability to problem-solve
* Ability to multi-task
* Ability to communicate effectively verbally and in writing
* Critical Thinking
* Ability to follow verbal instructions
JOB FUNCTIONS:
Using internal systems, analyzes and resolves outstanding claims. Ensures clean, compliant, and timely submission of claims to
third party payers. Resolves pre-bill edits and payer rejections according to established timeframes. Processes claims to insurance
carrier. Obtains and submits supporting documentation as needed per payer guidelines to facilitate claim payment. Escalates
problem accounts to supervisor if unable to resolve timely. Ensures payer timely filing guidelines are met to avoid denials.
Possesses a working knowledge of HCPCS, CPT and ICD-10 coding guidelines. Stays current on insurance billing rules and
regulations. Identifies reason for non-payment of account. Takes appropriate action to resolve accounts and collect money due.
Identifies and resolves denials, payment variances and credit balances. Performs timely account follow-up on unpaid claims by
contacting payer for claim status. Documents follow-up actions in patient account notes per operational standards. Composes
appeal correspondence and processes appeals according to payer guidelines. Ensures receipt of the appeal and monitors the
payer’s status. Documents actions in account notes per operational standards. Verifies and updates patient
demographic/insurance information in the host system accurately and timely. Collaborates with and notifies other departments
that may need to be aware of information updates. Identifies uncollectable balances, documents reason for non-payment, and
submits account for write-off as a last resort. Resolves credit balances. Transfers patient overpayments to open balances.
Submits patient or insurance refund requests to management according to standard procedure. Identifies trends and
recommends action plans for improvement to management. Escalates significant problem accounts for further action based upon
account balance or aging. Multi-tasks and performs a variety of duties for resolution of accounts receivable. Maintains a
consistent, high level of quality and productivity. Identifies distractions and recurring problems that affects your productivity.
Performs consistently throughout the fiscal year within established targets for quality and accuracy of transactions. Performs
consistently throughout the fiscal year to meet 100% of productivity goals. Achieves KPI goals established for the Revenue Cycle.
The Revenue Cycle Team functions as a whole regardless of the assigned individual daily tasks. If one person is out of the office
for more than one business day, the work shall be divided among the team. As a team, everyone is expected to assist one.
Maintains a positive work environment and is willing to help with any function. Achieves established goals/KPI’s for Revenue Cycle
through reporting, analyzing, and working with the team. KPI’s may include cash, collection rates, DRO, AR aging, credit balances
and denials in accordance with SLA’s and SLE’s.