Revenue Recovery Specialist II

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Presbyterian is seeking a Revenue Recovery Specialist II for Patient Accounting to validate, analyze and quantify identified payment variances. Organizes and submits an in-depth payer appeal package to the Supervisor of Revenue Recovery, which outlines all payments that have been assigned as a discrepancy to contracted terms. Requires extensive knowledge of contractual agreements, contract interpretation, reimbursement methodologies and configuration. Will serve as a subject matter expert for all reimbursement issues including maintenance of all fee schedules. Will be the lead in the validation process of the contract load in our contract compliance software. Will act as a liaison for the Revenue Recovery Supervisor when taking corrective action against the payers

Some key responsibilities include:

• Primarily responsible to validate, analyze and quantify identified payer specific trends provided by Revenue Recovery Specialist I
• Must report validated payer specific trends up to Revenue Recovery Supervisor for payer intervention
• Will take part in reporting variances to our various payers including running reports on variances as a result of their contract load issues.
• Ability to lead and facilitate work going out to Revenue Recovery Specialist I
• Primarily responsible to review, test and validate the contract load in contract compliance software.
• Will run validation reports and make recommendations on any configuration changes that need to be made.
• Will work with various other departments to ensure changes are made and again validate for accuracy.
• Maintain and apply knowledge of complex reimbursement methodologies.
• Must be a resource for follow up and denial teams to answer reimbursement related questions.
• Demonstrates excellent analytical, problem solving, investigative and research ability during the configuration of contracts and fee schedules and throughout the validation process.
• Performs other related tasks and projects as assigned

Qualifications:

• Three (3) to five (5) years experience in a Hospital or Physician medical claims processing, insurance billing or insurance collections environment.
• Must have working knowledge of reimbursement methodologies i.e. DRGs, OPPS fee schedule, Medicare APCs, multiple surgical rules etc. Must possess organizational skills, the ability to analyze reports and work within our contract compliance system.
• Needs to be very detail orientated and have a thorough understanding of the life cycle of an insurance claim including being able to interpret payer 835 data.
• Must demonstrate strong analytical skills, strong interpersonal skills, and the ability to interface with various departments within the revenue cycle.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.