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Eskenazi Health · 14 hours ago

Revenue Recovery Consultant

Greater Indianapolis

Full-time

Onsite

Entry, Mid Level

2+ years exp

Eskenazi Health is seeking a Revenue Recovery Consultant to monitor, analyze, and appeal various payer hospital and outpatient claim payment variances. The role involves optimizing revenue recovery and assessing contract compliance while communicating reimbursement issues to management.

Health Care

Hiring Manager

Chalise A.

Responsibilities

Perform a variety of tasks related to developing a knowledgebase and understanding of government payer regulations, terms of third-party payer regulations and contracts, coverage and benefit plans, coordination of benefits, DRG and clinical validation assignment, payment terms and all other conditions affecting payment, appeal of payment variances and correct payment calculation

Use internal data and systems to identify, document, track and summarize payment variances to determine appropriate actions to be taken so as to initiate appeals and to address inaccurate reimbursement in a timely manner

Analyze internal processes, technical system issues and payer processing/system issues and determine/communicate corrective actions in order to resolve payment variances

Perform a variety of tasks, in conjunction with Managed Care Contracting and Government Payers Department staff, to achieve most accurate payer and contract modeling in the decision support system

Document appeals of payment variances and reimbursement amounts recovered through the various appeals processes