Revenue Recovery Specialist

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

Location

Location: Avera Health Worker Type: Regular Work Shift: Day Shift (United States of America)

Pay Range

Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $19.50 - $25.50

Position Highlights

You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible for researching, analyzing and validating accounts to resolve denials, inappropriate payment and non payment of claims. The Specialist will identify, review and interpret third party payments, adjustments, denials, and facilitate appeals. Responsible for taking the appropriate action needed to correct the account, complete the correction or omission, and maintain documented action to follow-up on the collection and optimization of accurate reimbursement for all appropriate payers.

What you will do

• Responsible for 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.
• Monitors & reports trending of third party reimbursement issues to next level leader for revenue cycle optimization.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Preferred Education, License/Certification, or Work Experience

1-3 years Related experience

Expectations and Standards

Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community. Promote Avera’s values of compassion, hospitality, and stewardship. Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. Maintain confidentiality. Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits

• You Need & Then Some Avera is proud to offer a wide range of benefits to qualifying part‑time and full‑time employees.
• We support you with opportunities to help live balanced, healthy lives.
• Benefits are designed to meet needs of today and into the future.
• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands‑on training and mentorship
• If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].
• At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law.