Homeoffice Specialist, Revenue Recovery en Ovationhealthcare
Ovationhealthcare · Brentwood, Estados Unidos De América · Remote
- Professional
DUTIES AND RESPONSIBILITIES:
Denial and Underpayment Analysis:
Utilize the Health Innovas "Pulse" platform to systematically review client accounts flagged for potential denials or underpayments.
Conduct deep-dive investigations into technical denials, including those related to eligibility, registration errors, missing authorizations, and other administrative issues.
Analyze explanation of benefits (EOBs) and compare actual payments against modeled payer contracts to precisely identify and quantify contractual underpayments.
Resolution and Recovery:
Correct data errors and resubmit claims in a timely manner to resolve technical denials.
Prepare detailed documentation and justification to support underpayment appeals and resolution efforts.
Collaborate with Clinical Appeals Specialists (RNs) and Certified Coders by gathering necessary documentation for complex clinical and coding-related denials.
Process Improvement and Reporting:
Diagnose the root cause of each denial and underpayment to identify trends by payer, service line, and denial reason.
Meticulously document all actions, findings, and communications within the Pulse platform to ensure a clear audit trail and support team collaboration.
Contribute to performance reports that provide actionable insights to both internal leadership and clients, helping to prevent future revenue leakage.
Team Collaboration:
Serve as a key resource for resolving complex payment issues, working alongside Payer Contract Specialists and Denial Management leadership.
Participate in ongoing training to master the Pulse platform and stay current on evolving payer rules and denial trends.
KNOWLEDGE, SKILLS, AND ABILITIES:
Strong foundational understanding of the healthcare revenue cycle, including claims submission, remittance processing, and follow-up.
Demonstrated analytical and critical thinking skills with a high level of attention to detail.
Excellent written and verbal communication skills, with the ability to clearly and concisely document account activity.
Proficient with computers and technology, with an aptitude for quickly learning and mastering new software platforms.
Prior experience specifically in denial analysis or underpayment identification.
Familiarity with reading and interpreting payer contracts and fee schedules.
Experience working within various payer portals and systems.
WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:
High School Diploma or equivalent required, Associate's or Bachelor's degree in a related field preferred.
Minimum of 2+ years of experience in healthcare accounts receivable (AR), hospital billing, or revenue cycle resolution.
Experience working within various payer portals and systems.
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:
100% Remote
Reliable high-speed internet connection is required for all remote/hybrid positions.
Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.
A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.
