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Recovery Audit Specialist

Location: Nashville, TN, United States
Job # 11315081
Date Posted: 08-30-2018
Recovery Audit Specialist
Nashville, TN 37214
M-F, 8am-4:30pm
Contract to hire
Pay: $20
Standard Background Check
Interview Process: Onsite Interviewà Decision
 
Our Client, an industry leading healthcare information technology company, is seeking to add a Recovery Audit Specialist to their TPM Recovery team.  As the Recovery Audit Specialist you will help support its Post-Payment Recovery product. 
 
Responsibilities:
 
  • Identify, analyze, and research denials, trends, and implements corrective actions to find solutions.
  • Contact health insurance carriers and Pharmacy Benefit Managers to follow up on any medical or Rx claim statuses.
  • Resolve denial and payment issues.
  • Can overturn denials via appeals, grievances, and reconsiderations.
  • Contacts health insurance carriers and Pharmacy Benefit Managers to follow up on medical and Rx claim status, when to expect payment, appeals as well as research over/under payments
 
Qualifications:
  • Experience with the healthcare revenue cycle management – At least 5 years.
  • Knowledge of Medicaid-based third-party solutions.
  • HS Diploma or equivalent.
  • Knowledgeable of governmental and commercial health plans/policies/statutes.
  • Have the ability to have claims adjusted for payment over the phone.
  • Advanced knowledge of accounts receivable operations, including claim billing and adjudication, follow-up and denial management, and payment posting and reconciliation
  • Works fluidly in an everchanging, fast paced environment
  • Strong organizational and follow up skills.
  • Knowledge of Pharmacy billing and follow up are preferred but not required
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