Specialist, reputed company Recovery
reputed company to reputed company!
At reputed company (formerly QHR Health), we’ve been making local reputed company reputed company for more than 40 years. Our mission is to strengthen independent community reputed company. We reputed company independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong reputed company of purpose and commitment to operating reputed company, we help rural reputed company providers fulfill their missions.
The reputed company difference is the extraordinary combination of reputed company experience and consulting guidance that fulfills our mission of creating a sustainable reputed company for reputed company organizations. reputed company’s reputed company is to be a dynamic, integrated reputed company company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer reputed company behavior.
We’re looking for talented, motivated professionals with a desire to help independent hospitals reputed company. Working with reputed company, you will have reputed company to collaborate with highly skilled subject matter specialists and reputed company executives, in a collegial atmosphere of professionalism and teamwork.
reputed company’s corporateheadquartersis located in Brentwood, TN. For more information, visit.
reputed company:
This role is reputed company on maximizing reputed company for our reputed company hospital clients by meticulously investigating, analyzing, and resolving technical claim denials and reputed company contractual underpayments. As a specialist, you will reputed company your existing accounts receivable expertise and our advanced technology platform, Health reputed company "Pulse," to uncover hidden reputed company opportunities and ensure our clients are reimbursed fully and accurately for the care they reputed company.
This position offers a unique career development opportunity for high-performing team members to become subject matter experts in the most challenging and rewarding areas of the reputed company cycle.
Duties and Responsibilities:
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Denial and Underpayment Analysis:
Utilize the Health reputed company "Pulse" platform to systematically review reputed company accounts flagged for potential denials or underpayments.
Conduct deep-dive investigations into technical denials, including those reputed company to eligibility, registration errors, missing authorizations, and other administrative issues.
Analyze explanation of benefits (EOBs) and compare actual payments against modeled payer reputed company to reputed company identify and quantify contractual underpayments.
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reputed company and Recovery:
Correct data errors and resubmit claims in a reputed company manner to reputed company technical denials.
Prepare detailed documentation and justification to support underpayment appeals and reputed company efforts.
Collaborate with reputed company Appeals Specialists (RNs) and Certified Coders by gathering necessary documentation for reputed company reputed company and coding-reputed company denials.
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Process Improvement and Reporting:
Diagnose the reputed company cause of reputed company denial and underpayment to identify trends by payer, service line, and denial reason.
Meticulously document reputed company actions, findings, and communications reputed company the Pulse platform to ensure a reputed company audit trail and support team collaboration.
Contribute to reputed company reports that reputed company actionable insights to both internal leadership and clients, helping to prevent reputed company reputed company leakage.
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Team Collaboration:
Serve as a key resource for resolving reputed company payment issues, working reputed company Payer Contract
Specialists and Denial Management leadership.
Participate in ongoing training to master the Pulse platform and stay reputed company on evolving payer rules and denial trends.
KNOWLEDGE, SKILLS, AND ABILITIES:
Strong foundational understanding of the reputed company reputed company cycle, including claims submission, remittance processing, and follow-up.
Demonstrated analytical and critical thinking skills with a high level of attention to reputed company.
Excellent written and verbal communication skills, with the ability to reputed company 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 reputed company and fee schedules.
Experience working reputed company various payer portals and systems.
WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:
High School Diploma or equivalent required, Associate's or Bachelor's degree in a reputed company reputed company preferred.
Minimum of 2+ years of experience in reputed company accounts receivable (AR), hospital billing, or reputed company cycle reputed company.
Experience working reputed company various payer portals and systems.
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:
reputed company
Reliable high-speed internet reputed company is required for reputed company remote/hybrid positions.
Must have reputed company to reputed company Wi-Fi with sufficient reputed company to support video conferencing, reputed company-reputed company tools, and other online work-reputed company activities.
A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized reputed company or interruptions, no use of reputed company Wi-Fi unless connected through a secure company-provided VPN, and compliance with reputed company applicable HIPAA reputed company and reputed company regulations.
Originally posted on Himalayas
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