Revenue Recovery Specialist

Job description

Have you noticed that when you go to the doctor, often no one there can tell you what it will cost? If you think that’s as problematic as we do, join us in our mission to fix it. Position Overview: The Revenue Recovery Specialist will play a critical role in ensuring accurate reimbursement and recovering lost revenue for outpatient service providers. This position involves interfacing with insurance carriers, analyzing claims data, and drafting appeals to recover underpaid and denied claims. The ideal candidate must have a strong understanding of outpatient reimbursement methodologies, intermediate Excel skills, and the ability to navigate payer processes independently. Key Responsibilities: Claims Research and Analysis: - Review claims data in pricing software to identify discrepancies between contracted rates and actual payments. - Research claims variances in outpatient patient accounting systems (e.g., athenahealth, Nextgen) - Deep-dive into payer contracts and manuals to understand “why” a claim has been underpaid or denied. - Review claim details, including coding, billing, and insurance information to verify payer payment discrepancies. Appeals and Follow-Up: - Communicate w...