Revenue Recovery Specialist (work comp)

Iowa Ortho; Iowa (LA); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Health insurance

401(k) with company match

Paid time off

Job summary

Iowa Ortho is seeking a WC Revenue Recovery Specialist to identify, investigate, and pursue reimbursement discrepancies and underpayments related to workers' compensation claims. This role collaborates with the Work Comp, Revenue Cycle, and Finance teams to maximize reimbursement and support payer accountability.

The position requires strong communication, medical billing knowledge, and attention to detail.

Qualifications

• High school diploma or Associates degree with relevant insurance/medical billing experience.
• Knowledge of CPT, HCPCS, ICD-10 and reimbursement methodologies is preferred.
• Strong communication and data entry accuracy in a fast-paced environment.

Responsibilities

• Identify, investigate, and pursue reimbursement discrepancies and underpayments.
• Maintain underpaid account inventory and follow-up via WC worklist.
• Collaborate with Work Comp, Revenue Cycle, and Finance teams to maximize reimbursement.

Skills

Accounts receivable

Medical billing

Communication

Data entry

Microsoft Office

Medical terminology

Attention to detail

Education

High school diploma

Associates Degree in Business or Insurance

Tools

NextGen

Excel

Outlook

Word

Job description

Description

The WC Revenue Recovery Specialist is responsible for identifying, investigating, and pursuing reimbursement discrepancies and underpayments related to workers' compensation claims. This role works collaboratively with the Work Comp, Revenue Cycle, and Finance teams to maximize reimbursement, improve revenue integrity, and support payer accountability.

Key Responsibilities

• Maintains underpaid account inventory ensuring active and current follow-up via the WC worklist.
• Maintain communication with leadership to obtain needed documentation to properly pursue underpayments and achieve collection recovery if applicable.
• Collaborate with the appropriate staff regarding contract and payer practice issues in order to improve revenue integrity
• Analyze and report payer reimbursement and underpayment trends.
• Generate and analyze reports to identify reimbursement opportunities and monitor recovery performance.
• Collaborate with payers, vendors, and internal stakeholders regarding reimbursement disputes and negotiated payment resolutions.
• Provides support to the work comp and revenue cycle team, including relaying messages and correspondences from defined payers.
• Communicate with adjusters, carriers, attorneys, employers, and other stakeholders via phone, email, fax, and written correspondence regarding reimbursement discrepancies.
• Perform payment audits on high-dollar workers' compensation claims.
• Monitor compliance with payer contracts and reimbursement expectations.
• Document recovery efforts within the WC Worklist.
• Prepare summaries and recommendations for leadership regarding payer performance.
• Assist in identifying contract improvement opportunities and reimbursement trends.
• Maintain a highly responsible and confidential nature
• Assist with other duties as assigned

Requirements

• High school diploma with four years of accounts receivable/insurance experience – or –
• Associates Degree in Business or Insurance with two years of medical billing and/or insurance experience required
• Possession of the ability to maintain composure when confronted with fast paced and stressful situations
• Knowledge of medical records and practice management computer systems (Currently: NextGen)
• Excellent communication skills
• Customer Service Skills by phone and e-mail
• Math skills to add, subtract, multiply and divide
• Basic computer skills; Microsoft Office Suite (Excel, outlook, word, etc)
• Ability to enter data into systems with minimal errors
• Medical Terminology and Medical Forms experience preferred but not required
• Working knowledge of CPT, HCPCS, ICD-10, medical billing practices, and reimbursement methodologies.
• Ability to utilize web tools, fee schedules, and contracts to work accounts efficiently and timely
• Ability to prioritize and demonstrated ability to manage details
• Ability to maintain composure during times of change or job assignments

Preferred

• Experience with workers' compensation reimbursement methodologies and contract analysis.
• Experience appealing underpaid or denied claims.
• Experience negotiating reimbursement disputes with carriers or third-party administrators

Why Choose Iowa Ortho?

At Iowa Ortho, We Are Guided By Our IMPACT Values, And We Believe In Fostering a Culture That Prioritizes Both Professional Excellence And Compassionate Care

• Innovation that Drives Positive Outcomes (I)
• Motivation for Exceptional Care (M)
• Passion for Quality in Everything We Do (P)
• Accountability Through Open and Honest Communication (A)
• Commitment to Continued Growth (C)
• Teamwork (T)
• Competitive Benefit Package: Competitive pay, health, dental, 160hrs paid time off, paid holidays, 401(k) with company match, profit-sharing, employee discounts and more.
• Center of Excellence: Physician-owned orthopedic clinic and surgery center dedicated to providing exceptional medical care to the people of central Iowa. Discover why Iowa Ortho is a recognized center of excellence in orthopedic care.
• Cutting-Edge Environment: Work in a state-of-the-art facility that embraces the latest advancements in medical technology.
• Team Atmosphere: Join a collaborative team that supports one another and is committed to enhancing patient care.
• Professional Growth: Opportunities for career advancement and continuous learning.