Revenue Recovery Specialist II - Patient Accounting
Revenue Recovery Specialist II - Patient Accounting
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Salary Not Disclosed
1 Vacancy
Job Description
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 its not just what we do that matters. Its 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.
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
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
Benefits
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
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges webinar preventive screening and more.
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
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned not-for-profit healthcare system of nine hospitals a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees - including more than 1600 providers and nearly 4700 nurses.
Our health plan serves more than 580000 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.
Maximum Offer for this position is up to
Compensation Disclaimer
Required Experience:
Unclear Seniority
Employment Type
Full-Time
