Revenue Recovery Consultant

FLSA Status

 Exempt

Job Role Summary

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

Essential Functions and Responsibilities

•    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, code 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 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 to resolve payment variances. 
•    Document cost savings and revenue recovered through various projects, workflow improvements, and analyses 
•    Must act as a change agent within the organization on current processes to improve process workflows
•    Works collaboratively with internal and external customers to ensure accurate and compliant documentation and utilization of resources
•    Partner with Decision Support Analytics to identify, trend, and work with Revenue Cycle departments on improvement work related to the reduction of denials and write-offs

Job Requirements

 •    Bachelor’s degree in finance, business, or healthcare related field required. In lieu of bachelor’s degree, minimum of 5 years relevant experience required
•    Minimum of 3 years Revenue Cycle experience
•    Minimum of two years’ analytics experience preferred
•    Minimum of two years denial appeal process preferred
•    Revenue Cycle billing experience preferred

Knowledge, Skills & Abilities

•    Project Management Professional (PMP) certification and/or Lean Six Sigma certification strongly preferred
•    Knowledge of inpatient and outpatient coding and billing  
•    Advanced problem-solving, analytical and critical thinking skills
•    Working knowledge of Joint Commission (JC), Indiana State Department of Health
•    (ISDH) and Centers for Medicare and Medicaid Services (CMS) regulations as they relate to medical documentation and health information management
•    Ability to work effectively with all levels of the organization, including physicians
•    Knowledge of clinical documentation management tools and techniques
•    Strong written and verbal communication skills
•    Strong positive attitude; competent interpersonal skills
•    Demonstrated leadership skills and strong organizational skills
•    Ability to work independently; motivated to produce high quality outcomes
•    Working knowledge of various software applications including EPIC and Excel preferred