Payment Recovery Specialist (Full-Time, 40, Day)

RESPONSIBILITIES

I. JOB SUMMARY/RESPONSIBILITIES:

• Responsible for analysis of denied reimbursement claims, including conducting payment audits, creating reports and implementing process changes, to minimize and/or prevent denials.

• Follows up on insurance claims with outstanding balances; leads meetings with payors to resolve payment and denial issues.

• Writes and submits appeals to payors on denied accounts.

• Audits payments to ensure QMC has received contracted payment in accordance with contract terms (including outlier accounts), including performing zero balance analysis. Creates, reviews and distributes accounts receivable reports on denials, audits, payment trends, and AR status.

• Meets with department staff and/or management to resolve issues resulting in denials and instruct on preventative measures to prevent/reduce future denials.

II. TYPICAL PHYSICAL DEMANDS:

• Essential: standing, sitting, walking, seeing, hearing, speaking.

• Frequent: finger dexterity, repetitive arm/hand motions and gripping of an object.

• Operates various office equipment such as computer, copier, facsimile, telephone, addressograph machine, pneumatic tube system etc.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION/CERTIFICATION AND LICENSURE:

• High School diploma or equivalent.

• Bachelor's degree in business or related field preferred.

B. EXPERIENCE:

• Four (4) years recent progressively responsible experience as a Patient Accounts Representative in an acute care facility, demonstrating good working knowledge of Medicare, Medicaid, Third Party payor requirements. SNF/ICF, ICD-9/ICD-10 and DRG.

• Prior experience in report preparation and analysis.

• Experience to demonstrate effective written and oral communication skills and interpersonal skills.

• Experience to demonstrate ability to lead/conduct meetings with other departments and staff.

• Experience with Windows applications, such as Word, Excel, etc.

• Experience with hospital accounts receivable and hospital billing systems.

Equal Opportunity Employer/Disability/Vet