Workers’ Revenue Recovery & Resolution SME

Workers’ Compensation Revenue Recovery & Resolution SME

Job Category: Reimbursement

Requisition Number: WORKE
001234

• Posted :
  September 1, 2026
• Full-Time

Showing 1 location

Altivera Corporate Office
8181 E Tufts Ave
Denver, CO 80237, USA

The role serves as a liaison between Billing, payers, TPAs, adjusters, payer representatives, and internal teams to resolve reimbursement barriers and maximize appropriate payment. It includes managing aging receivables, reviewing AR reports, identifying recovery opportunities, and determining actions based on contracts, authorization requirements, payer rules, and billing guidelines.

This role requires strong knowledge of Workers’ Compensation billing, payer requirements, authorizations, appeals, contracts, fee schedules, claims processing, reimbursement, and revenue cycle management, with the ability to analyze balances, identify recovery opportunities, and drive claims toward resolution.

• Workers’ Compensation & Reimbursement Knowledge: Strong understanding of Workers’ Compensation processes, payer requirements, DME authorization, medical documentation, fee schedules, contracts, claims processes, injury claim lifecycle, and reimbursement requirements.
• Denials & Appeals Expertise: Demonstrated ability to evaluate denial rationale, determine whether a denial is appropriate, and apply effective appeal, reconsideration, correction, or other recovery strategies.
• AR & Revenue Recovery: Strong understanding of AR management, aging, payment resolution, underpayments, and revenue recovery strategies, with the ability to prioritize accounts based on financial impact, age, and likelihood of recovery.
• Analytical & Problem-Solving
  
  Skills:
  
  Ability to analyze complex claims, denial trends, payer behavior, payment patterns, and process issues to identify root causes, recovery opportunities, and solutions.
  Immediately reports payment and claims processing disruption to leadership.
• Payer Communication & Negotiation: Strong communication and negotiation skills with the ability to effectively work with carriers, TPAs, adjusters, and payer representatives to advocate for appropriate reimbursement and resolve complex issues.
• Case & File Review: Ability to review claims and supporting documentation across the patient’s file to identify authorization, billing, coverage, or other issues that may affect reimbursement.
• Judgment & Decision-Making: Ability to assess claim circumstances, payer requirements, financial impact, and available options to determine the most appropriate course of action and when escalation is necessary.
• Organization & Follow-Through: Strong attention to detail and ability to manage multiple claims, priorities, deadlines, payer follow-ups, appeals, and resolution activities while maintaining accurate documentation. Uses information on claims processing to support effective prevention strategies.

• Develop and maintain professional relationships with insurance carriers, TPAs, adjusters, nurse case managers, and payer representatives.
• Serve as a primary point of contact for assigned reimbursement issues and recovery efforts.
• Advocate for appropriate claim adjudication and reimbursement.
• Collaborate with internal departments to obtain documentation and support claim resolution.
• Facilitate productive communication between external payers and internal operational teams.
• Support payer issue escalation and reimbursement resolution initiatives

• Manage complex Workers’ Compensation denials, underpayments, and outstanding accounts receivable.
• Investigate reimbursement barriers and determine the appropriate resolution strategy.
• Identify opportunities to recover revenue through appeals,…