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Form of workRevecore 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, regardless of where you are located—we want you on our team!
Location: Remote
Position Summary
Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.
Duties and Responsibilities
- Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims.
- Review, analyze and interpret managed care contracts and healthcare claims
- Build strong, lasting relationships with clients, payors and Revecore personnel
- Review insurance contracts to gain thorough understanding of payment methodologies
- Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
- Contact insurance company to obtain missing information, explain and resolve denials and arrange for payment or adjustment processing on behalf of client
- 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.
- Attend client, department and company meetings
- Comply with federal and state laws, company policies and procedures
- All other duties as assigned
Skills and Experience
- Minimum 2 years of denial management and/or utilization review experience
- Experience reviewing and analyzing hospital claims
- Knowledge of healthcare codes including CPT, ICD-9, HCPC, DRG, and ability to correctly use and apply codes in operational setting
- High school diploma or equivalent
- Microsoft Excel
- Microsoft Word
- 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
- Strong team player
- Commitment to company values
Physical Demands and Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical Demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to handle or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
- Work Environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.
Why Join Revecore?
- Fully remote work.
- Medical, dental, vision, and life insurance benefits are available from the first day of employment.
- 401(k) with employer match after 90 days.
- Generous PTO plan
- 12 paid holidays
- All computer and necessary hardware are provided to you.
About Revecore
As a multi-year award winning services team, we partner with hospitals and health systems to become a trusted advisor and extension of their billing office.
Our Revenue Integrity division, based out of Crescent Springs, KY and Cincinnati, OH, specializes in identifying, recovering, and preventing underpayments and denials from commercial and government payers. Our data-driven solutions are fueled by The Bridge, our proprietary technology that delivers actionable intelligence and our people allow us to leverage that technology to strengthen a hospital’s internal systems and prevent future losses.
Our Complex Claims division, based out of Franklin, TN, delivers reimbursement solutions that identify and recover overlooked revenue for hospitals and health systems nationwide. AcciClaim, our innovative technology platform seamlessly resolves accident-related medical claims, securing accurate reimbursement while eliminating the administrative pain of billing for Motor Vehicle and Workers’ Compensation accidents and Veterans Affairs Claims.
Revecore is committed to creating a diverse and inclusive work environment where all employees feel valued, respected, and supported. Our company 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 value diversity and inclusion and believe that everyone should be treated with respect and dignity. We encourage all qualified individuals to apply for our open positions and welcome candidates from all backgrounds to join our team.
This opportunity is remote and open to candidates in 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.
