AR Recovery​/Healthcare Denials Specialist III

Impact you will make

Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve.

We’re looking for an experienced Healthcare Denials Specialist to analyze and resolve payer denials and underpayments. You'll be part of a dynamic team using cutting-edge ARO software to streamline medical claims and collections. As a Denials Specialist II, you will also have the opportunity to mentor junior representatives.

Reps typically demonstrate the aptitude and ability to take on critical processes while managing quality production standards. Acts as a mentor to Rep I&Rep IIassociates.

Responsible for managing moderately complicated insurance denials and underpayments via theRubixisAR Follow Up software.

• Learn and understand our Rubixisplatform and the various resources available
• Work an assigned number of accounts from start to finish successfully, and in a timely manner
• Call healthcare insurance companies, their affiliates&providers to resolve any question about contract or payment issues
• Analyze contract, billing, cash costing, pricing, and collections on accounts in compliance with billing regulations,policies,and
• Procedures
• Investigate all insurance payments that deviate from expected payment
• Work collaboratively with leadership and other team members to confirm, challenge, or provide trending and solutions

• 5+ years Hospital Billing with follow up experience, with advanced knowledge of all pay or types, who will be able to manage day-to-day operational tasks associated with medical insurance billing and follow
• Knowledge of Medicare payer rules, processes, including how to interpret denial reasons, how to submit appeals to Medicare payer, and access Medicare portals
• Ability to use Medicare Direct Data Entry (DDE) to submit claim corrections, adjustments, and inquiries as needed
• Detailed understanding of insurance follow-up (i.e.,resolving non-paid, denied, under-paid, and rejectedclaims) for healthcare providers
• Experience in UB04 Facility Pricing and Reimbursement variance
• Good understanding of revenue cycle
• Basic understanding of HIT systems like EPIC, Paragon,Zirmed,or other billing systems
• Problem solving / superior analytical skills
• An organized and detail-orientedaptitude

• Bachelor’s or associate degree
• 2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of both pricing and reimbursement variances
• 2+ years of experience with Medicare processes and systems
• Detailed knowledge of Facility Reimbursement contracts, fee schedules, reimbursement procedures
• Advanced MS Excel skills

Fin Thrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.

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