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SalaryRevecore is an innovative, technology-driven company that is committed to helping our clients, our employees, our company, and our communities thrive. An award-winning services firm, partnering with hospitals and health systems, providing the momentum they need to maintain a strong revenue cycle amid today’s evolving healthcare environment.
With a 20+ year history, Revecore is the leading provider of revenue integrity and complex claims solutions for hospitals.
We offer a dynamic and flexible work environment, full of opportunity for motivated, hands-on team players. We strive each day to solve complex business problems and find new ways to enhance the efficiency, effectiveness, and quality of our services. If those attributes resonate with you, we want you on our team!
Why Join Revecore?
- Paid training and incentive plans depending on the role
- Medical, dental, vision, and life insurance benefits are available from the first day of employment.
- 401(k) with employer match after 90 days.
- Career growth opportunities
- Generous PTO plan
- 12 paid holidays
- Computers and necessary work equipment are provided
Location: Remote-USA
The Role:
Join our innovative team as a Denial Prevention Claims Analyst. Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client. Apply now and become an integral part of our mission to deliver efficient, accurate, and compassionate healthcare payment solutions!
As a Denial Prevention Claims Analyst, you will:
- Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims
- Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
- Review insurance contracts to gain thorough understanding of payment methodologies
- Contact insurance company to obtain missing information, explain and resolve denials and arrange for payment or adjustment processing on behalf of client
- Follow up on claims in a timely fashion as outlined in Revecore and/or departmental policies and procedures
- Document information in appropriate Revecore and client systems
- Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
- Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel
- Communicate with client contact concerning all issues related to billing, posting, contracts and all other client related issues, both in an informal manner through daily contact and formal manner through scheduled meetings
- Promotes positive public relations for Revecore, including maintaining a professional attitude and approach with all payors
- Build strong, lasting relationships with clients, payors and Revecore personnel
- Support and direct claims to all Revecore departments and client onsite analysts
- Attend client, department and company meetings
- Comply with federal and state laws, company policies and procedures
- All other duties as assigned
You will be successful if you have:
- Working knowledge of Microsoft Office suite (Word, Excel)
- Moderate computer proficiency
- Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
- Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
- Ability to write routine correspondence (in English)
- Ability to define problems, collect data, establish facts and draw valid conclusions
- Strong customer service orientation
- Excellent interpersonal and communication skills
- Commitment to company values
Education and Experience Requirements:
- Minimum 2 years of insurance billing, denial management and/or utilization review experience:
- Experience reviewing and analyzing hospital claims
- Knowledge of healthcare codes including CPT, ICD-9, ICD-10, HCPC, DRG, and ability to correctly use and apply codes in operational setting
- High school diploma or equivalent
- Must reside in the United States within one of the states listed below:
Alabama, Arkansas, Arizona, Connecticut, Delaware, Florida, Georgia, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin, and West Virginia.
Work at Home Requirements:
- A quiet, distraction-free environment to work from in your home
- A reliable hard-wired private internet connection that is not supplied via cellular data or hotspot is required.
- Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
- The workspace area accommodates all workstation equipment and related materials, and provides adequate surface area to be productive.
Revecore is an equal opportunity employer that does not discriminate on the basis of race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status.
We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply.
