Revenue Management Recovery Specialist

Description : Job Summary :

Revenue Management Recovery team will design and deploy strategic delivery arm of revenue cycle that will deliver the changes, Team assembled to perform root cause analysis and remediation to investigate issues in accounts and identify solutions and collaborate with regions and KPHC for ongoing corrections Revenue Management recovery processes, including, delinquency management, internal collections and third party payer management.

To manage the quality and timeliness of billing and recovery. To gain valuable insight into the group recovery risks in the group and identify, educate and collaborate with all Regions to close the loop on the root issues creating the underpayments.

This Department leverages both transaction level information as well as powerful financial analytics to professionally collect monies owed Kaiser Permanente.

The Revenue Management Recovery department continually seeks to gain a higher level of financial transparency to identify, analyze, correct and recover payments on grossly underpaid claims that are currently written off to contractual adjustment.

Critical management reporting functions include : be the safety net for all regions as unplanned issues cause, Accounts Receivables to go unbilled or worked and balances are unnecessarily written off continuous account monitoring, predicting bad debt exposure, proactive risk analysis, payment terms analysis.

The Revenue Management Recovery department is responsible for providing consultative leadership in; establishing and maintaining strong internal controls over billing processes and root cause analysis of recovery concerns.

Essential Responsibilities :

• Recommends changes to revenue collection based on analysis of recovery trends.
• Negotiates with third party payors to recover funds for grossly underpaid claims.
• Provide collection status and recommendations to Manager of Recovery.
• Investigates and does root cause analysis of billing processes on closed or claims considered lost to identify and pursue recovery.

Prepares written monthly and quarterly reports summarizing the activities of the various segments.

Investigate issues and complete special projects as designated by the Manager.

Basic Qualifications : Experience

Minimum five (5) years directly related experience in credit collections, revenue management, healthcare insurance billing or similar field required.

Education

• Bachelors degree in Finance and Accounting, Business Administration, or a related field, OR four (4) years directly related experience required.
• High School Diploma or (General Educational Development (GED) required.

License, Certification, Registration

N / A

Additional Requirements :

• Excellent spreadsheet (Excel), word processing (Word), and database skills.
• Excellent written and verbal communication and presentation skills.
• Understanding of revenue cycle, change control, root cause analysis.
• Knowledge of healthcare revenue capture and documentation guidelines.
• Skilled at researching and interpreting Federal, State and Insurance Company regulations.
• Experienced at questioning and challenging regulations and errors with insurance companies non-Kaiser Insurance Companies.
• Experienced validating clinical services documented in medical record to amounts charged.
• Extensive Healthcare Insurance industry experience.
• Must be able to work in a Labor / Management Partnership environment.

Preferred Qualifications :

• Ten (10) years directly related experience in credit collections, revenue management, healthcare insurance billing or similar field preferred.
30+ days ago