Insurance Recoupment Specialist Revenue Integrity FT 1.0 (80 hrs biweekly) (63945)

Reno, NV - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Description

In an environment of continuous quality improvement the Insurance Recoupment Specialist is responsible for managing and resolving insurance recoupments offsets and take-backs to ensure accurate and compliant revenue recognition within the health system. This role supports the Revenue Integrity Department by identifying researching validating and reconciling payer-initiated recoupments as well as working collaboratively with internal departments and payers to prevent inappropriate recoveries and maintain compliance with payer contracts and regulatory requirements.

Job Functions:

Review analyze and reconcile insurance recoupments take-backs offsets and overpayment requests from payers.
Validate the accuracy and legitimacy of payer recoupments in accordance with payer contracts billing regulations and internal policies.
Coordinate with Patient Financial Services Coding Compliance and Contracting teams to research and resolve disputed recoupments or incorrect adjustments.
Initiate appeals or refund requests when payer recoupments are found to be inaccurate or non-compliant.
Monitor and track recoupment activity in the billing system to ensure proper financial reporting and timely resolution.
Participate in Revenue Integrity initiatives to improve charge capture accuracy compliance and revenue protection.
Prepare detailed documentation to support findings appeals and audit responses.
Utilize independent judgment and exercise discretion to ensure timely review and auditing of recouped claims.
Identify root causes of recoupment trends and collaborate with internal teams to implement corrective actions or process improvements.
Maintain current knowledge of payer policies reimbursement methodologies and federal/state regulations affecting overpayments and recoupments.
Assist with developing and maintaining reporting metrics related to recoupment volumes trends and financial impact.
Consistently maintain productivity and accuracy standards in highly challenging environment.
Assumes all other duties and responsibilities as necessary.

Qualifications

Minimum Education/Experience Required:

An Associates degree (or equivalent experience) in a healthcare-related field is required.
Bachelor degree (or equivalent working experience) in a healthcare-related field is preferred.

Special Knowledge Skills Training:

Demonstrated leadership skills.
Excellent verbal presentation and written communication skills.
Advanced critical thinking problem-solving and analytical abilities.
Ability to inspire and influence others to accomplish goals.
Ability to work effectively under strict time constraints.
Flexibility to manage changing priorities.
High standards for performance quality credibility and integrity.

Compensation Details: Education experience and tenure may be considered along with internal equity when job offers are extended.

Benefits: Memorial Health System is proud to offer an affordable comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer please visit our website at

Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.

Memorial Health System is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination complete the USDA Program Discrimination Complaint Form found online at or at any USDA office or call to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue S.W. Stop 9410 Washington D.C. 20250-9410 by fax or email at.

*Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.

Required Experience:

DescriptionIn an environment of continuous quality improvement the Insurance Recoupment Specialist is responsible for managing and resolving insurance recoupments offsets and take-backs to ensure accurate and compliant revenue recognition within the health system. This role supports the Revenue Inte...

Description

Job Functions:

Review analyze and reconcile insurance recoupments take-backs offsets and overpayment requests from payers.
Validate the accuracy and legitimacy of payer recoupments in accordance with payer contracts billing regulations and internal policies.
Coordinate with Patient Financial Services Coding Compliance and Contracting teams to research and resolve disputed recoupments or incorrect adjustments.
Initiate appeals or refund requests when payer recoupments are found to be inaccurate or non-compliant.
Monitor and track recoupment activity in the billing system to ensure proper financial reporting and timely resolution.
Participate in Revenue Integrity initiatives to improve charge capture accuracy compliance and revenue protection.
Prepare detailed documentation to support findings appeals and audit responses.
Utilize independent judgment and exercise discretion to ensure timely review and auditing of recouped claims.
Identify root causes of recoupment trends and collaborate with internal teams to implement corrective actions or process improvements.
Maintain current knowledge of payer policies reimbursement methodologies and federal/state regulations affecting overpayments and recoupments.
Assist with developing and maintaining reporting metrics related to recoupment volumes trends and financial impact.
Consistently maintain productivity and accuracy standards in highly challenging environment.
Assumes all other duties and responsibilities as necessary.

Qualifications

Minimum Education/Experience Required:

An Associates degree (or equivalent experience) in a healthcare-related field is required.
Bachelor degree (or equivalent working experience) in a healthcare-related field is preferred.

Special Knowledge Skills Training: