Revenue Recovery Specialist – Medical Collections

The Revenue Recovery Specialist in Medical Collections is a critical role responsible for reviewing and analyzing unpaid medical claims from insurance companies that are older than six months to a year. The primary duties include:

1. **Claim Analysis:** Review and analyze unpaid medical claims from insurance companies that are older than six months to a year. This involves understanding the details of each claim, including the services provided, the billing codes used, and the reasons for non-payment.

2. **Investigation:** Delve into the reasons why these claims have not been paid. This could involve liaising with insurance companies, healthcare providers, and patients to gather more information or to clarify discrepancies.

3. **Problem Solving:** Identify possible solutions to get these claims paid. This could involve correcting errors in the claim, providing additional documentation to the insurance company, or negotiating with the insurance company on the claim amount.

4. **Communication:** Maintain clear and consistent communication with insurance companies, healthcare providers, and patients throughout the claim resolution process. This includes explaining complex billing issues in a clear and understandable way.

5. **Documentation:** Keep detailed records of all actions taken on each claim, including conversations with insurance companies, healthcare providers, and patients. This ensures a clear audit trail and can help with future claim resolution.

6. **Continuous Improvement:** Stay up-to-date with changes in insurance policies, healthcare regulations, and billing practices to ensure that all claims are submitted and processed according to the latest guidelines.

The ideal candidate for this role should have strong analytical skills, excellent problem-solving abilities, and outstanding communication skills. A background in healthcare billing or insurance is highly beneficial. The ability to work independently and manage multiple claims simultaneously is essential.

This role plays a crucial part in the revenue cycle of healthcare providers and contributes significantly to their financial health. It requires a detail-oriented and diligent professional who is committed to ensuring that all claims are accurately paid in a timely manner.
Must be able to use your own judgment regarding issues
please only apply for job if you have previous job experience