Revenue Recovery Consultant, RN

Division:Eskenazi Health  

Sub-Division:   

Req ID:  24525 

Schedule: Full Time 

Shift: Varied 

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

JOB SUMMARY:

The Clinical Revenue Recovery Consultant is responsible for monitoring, analyzing, and appealing government, managed care, and commercial payer hospital and outpatient hospital-based patient claim payment variances to optimize revenue recovery, assess contract compliance, and communicate contract and reimbursement issues to management.

ESSENTIAL JOB FUNCTIONS:

• Perform a variety of tasks related to developing a knowledge-base 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.

ASSOCIATED JOB DUTIES:

• Must act as a change agent within the organization on current processes to improve documentation
• Works collaboratively with internal and external customers to ensure accurate and compliant documentation and utilization of resources
• Recommends audit and documentation policy changes/new policies to Manager as necessary to ensure compliance
• Perform special projects, as assigned

JOB REQUIREMENTS:

• RN, current state licensure required

• Two years of Utilization Review experience
• CDI experience preferred
• Revenue Cycle experience strongly preferred

Accredited by The Joint Commission and named as one of Indiana’s best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health’s programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city’s primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.