Claims Denials & Revenue Recovery Analyst

Avera Health; Sioux Falls (SD); On-site; USD 26,000 - 34,000; Full time

Benefits offered by this job

PTO day 1 for eligible hires

Up to 5% employer retirement match

Career development and mentorship

Job summary

Avera Health in Sioux Falls, SD is seeking a Specialist to research, analyze and validate accounts to resolve denials, improper payments and non-payments of claims. The Specialist will identify, review and interpret third-party payments, adjustments, denials, and facilitate appeals.

The role requires taking corrective actions to ensure accurate reimbursement, maintaining documented actions, and following up on collections and optimization across payers.

Qualifications

• 1-3 years related experience

Responsibilities

• Account review and follow up on unpaid claims for resolution.
• Research for appropriate information and process claims with corrected claim information or appeal.
• Reconciles patient accounts to ensure the payment, balance or refund is correct.
• Collaborate with internal departments to ensure claim accuracy for timely processing.
• Monitor and review payer correspondence for claim processing updates, claim audits and denials, and refund requests.
• Serves as a resource to various departments within the Central Business Office to answer questions with regard to network discounts, reimbursement, provider networks, and government payers.

Education

1-3 years Related experience

Job description

Avera Health in Sioux Falls, SD is seeking a Specialist to research, analyze and validate accounts to resolve denials, improper payments and non-payments of claims. The Specialist will identify, review and interpret third-party payments, adjustments, denials, and facilitate appeals.

The role requires taking corrective actions to ensure accurate reimbursement, maintaining documented actions, and following up on collections and optimization across payers.