Day (United States of America)

Recovery Reimbursement Analyst

The Recovery Reimbursement Analyst I is responsible for managing and resolving outstanding insurance claims, including denials, unadjudicated balances with no payer response and claims requiring technical appeal submissions for technical hospital claims. This role requires an understanding of payer policies, medical billing codes and hospital reimbursement protocols. This analyst will work directly with insurance companies and internal departments to ensure timely and accurate reimbursement and resolve any discrepancies in the hospital’s accounts receivable balances.

Associate or bachelor’s degree or relevant certification from accredited institution preferred. Requires a minimum of three years previous experience in healthcare (or one year healthcare experience with an associate or bachelor’s degree) with two years of claim experience in hospital billing with complete familiarity of the third-party billing and collection process. Must have general PC operational knowledge and skills. Experience in Epic Resolute Hospital Billing or equivalent experience preferred.

JOB RESPONSIBILITIES AND STANDARDS

• Review and analyze denied claims to determine the reason for denial and identify any necessary follow-up action

• Work accounts that are not paid at the primary expected reimbursement based on hospital agreement with payer or entity; submit reconsiderations and follow-up to receive appropriate reimbursement

• Submit technical appeals to insurance payers, ensuring all necessary documentation is included and adheres to payer requirements

• Follow-up on submitted appeals to track status, ensure timely resolution and minimize adverse financial impact

• Investigate payment discrepancies from claim submission to 835 remittance of payment if denial adjudication does not reconcile to original submission

• Work closely with billing and managed care teams to gather relevant documentation and information required for appeals and dispute resolution

• Collaborate with internal teams to identify root causes and suggest solutions for continuous improvement

• Maintains current knowledge of CPT / HCPCS and ICD-10 coding in accordance with insurance payer guidelines for UB04 claim forms.

• Provide accurate reporting at account level work and re-work to support managed care initiatives and track payer behaviors

• Maintains knowledge of insurance payer contracts in accordance with insurance payer guidelines

• Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with co-workers and customers.

• Other duties as assigned.

Completion of the assigned training modules

Internal Candidates must be without infractions for twelve months

Understands the LCDs and Rules and Regulations of CMS

Basic Excel knowledge

Basic analytical skills

Ability to solve problems

WORK CONDITIONS: The individual spends almost 100% of their time in an air-conditioned building with minimal exposure to excessive humidity and noise.