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REVENUE RECOVERY SPECIALIST II

Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: February 16, 2020

Job Description:

Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: DaysSummary: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.Primarily responsible to validate, analyze and quantify identified payer specific trends provided by Revenue Recovery Specialist IMust 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 s.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.SKILLS: Three to five 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 GEDBenefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programsAbout Us Presbyterian Healthcare Services is a 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, it is the state's largest private employer with approximately 11,000 employees.Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. JC123CBRequisition ID: 2019-12471 Street: 9521 San Mateo NE Name: REVENUE RECOVERY JobTitle: REVENUE RECOVERY SPECIALIST II

Keywords: Presbyterian Healthcare Services, Albuquerque , REVENUE RECOVERY SPECIALIST II, Other , Albuquerque, New Mexico

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