AR Recovery/Healthcare Denials Specialist III

About the Role Impact you will make Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve. We’re looking for an experienced Healthcare Denials Specialist to analyze and resolve payer denials and underpayments. You'll be part of a dynamic team using cutting-edge ARO software to streamline medical claims and collections. As a Denials Specialist II, you will also have the opportunity to mentor junior representatives. Reps typically demonstrate the aptitude and ability to take on critical processes while managing quality production standards. Acts as a mentor to Rep I & Rep II associates. Responsible for managing moderately complicated insurance denials and underpayments via the Rubixis AR Follow Up software.

What you will do

• Learn and understand our Rubixis platform and the various resources available
• Work an assigned number of accounts from start to finish successfully, and in a timely manner
• Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues
• Analyze contract, billing, cash costing, pricing, and collections on accounts in compliance with billing regulations, policies, and
• Procedures
• Investigate all insurance payments that deviate from expected payment
• Work collaboratively with leadership and other team members to confirm, challenge, or provide trending and solutions

What you will bring

• 5+ years Hospital Billing with follow up experience, with advanced knowledge of all pay or types, who will be able to manage day-to-day operational tasks associated with medical insurance billing and follow
• Knowledge of Medicare payer rules, processes, including how to interpret denial reasons, how to submit appeals to Medicare payer, and access Medicare portals
• Ability to use Medicare Direct Data Entry (DDE) to submit claim corrections, adjustments, and inquiries as needed
• Detailed understanding of insurance follow-up (i.e., resolving non-paid, denied, under-paid, and rejected claims) for healthcare providers
• Experience in UB04 Facility Pricing and Reimbursement variance
• Good understanding of revenue cycle
• Basic understanding of HIT systems like EPIC, Paragon, Zirmed, or other billing systems
• Problem solving / superior analytical skills
• An organized and detail-oriented aptitude

What we would like to see

• Bachelor’s or associate degree
• 2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of both pricing and reimbursement variances
• 2+ years of experience with Medicare processes and systems
• Detailed knowledge of Facility Reimbursement contracts, fee schedules, reimbursement procedures
• Advanced MS Excel skills

is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.

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’s Core Values and Expectations

• Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to ’s core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
• Support ’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to ’s business practices; this includes becoming familiar with ’s Code of Ethics, attending training as required, notifying management or ’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations

Physical Demands

The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Statement of EEO values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.

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is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations. © 2024 . All rights reserved. The name, products, associated trademarks and logos are owned by or relat ed entities. RV092724TJO

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