Revenue Recovery Consultant

Job description

Division: Eskenazi Health Sub-Division: Hospital Req ID: 26034 Schedule : Full Time Shift : Days Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis. 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 Accredited by The Joint Commission and named as one of Indiana’s best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute , Eskenazi Health’s programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city’s primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.