Healthcare Payer Payment Recovery Specialist

GENESISCARE USA SERVICES LLC (S21 / XYW) • Full-time • ADM | Admin [CORP], United States of America • 1w ago

At GenesisCare we want to hear from people who are as passionate as we are about innovation and working together to drive better life outcomes for patients around the world.

Healthcare Payer Payment Recovery Specialist

Role Summary:

Responsible for identifying underpaid payment discrepancies for Managed Care, Government and commercial payers plans, caused when explanation of benefits allowable do not meet expected payment. Expected payments are based on contracts with insurance companies or government mandated amounts.

Your Key Responsibilities:

Evaluate variances on paid claims

Interpret and calculate payer contract reimbursement methodology

Stay abreast of payer and contract updates per department process

Attends bi-weekly meetings

Works independently to identify collectable underpaid amount.

Ensure reimbursement and follow up is accurate timely and compliant

Initiates timely appeals and reconsideration with payers by telephone, letter, email or other electronic media or spreadsheets

Track and document underpayment reconsideration and appeals

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Other duties as assigned.

Minimum Qualifications:

Bachelors degree analytics, healthcare administration, or related field or equivalent work experience required.

Experience in Commercial insurance collections, including submitting and following up on claims

Understanding explanation of benefits

Must be familiar with revenue cycle structure and process. Knowledge of CPT, HCPCS codes

Preferred Qualifications:

Experience with Practice Analytics, Intergy

About GenesisCare:

An integrated oncology and multispecialty network in Florida and North Carolina providing care for more than 120,000 patients annually, GenesisCare U.S. offers community-based cancer care and other services at convenient locations. The company’s purpose is to redefine the care experience by improving patient outcomes, access and care delivery. With advanced technology and innovative treatment options, skilled physicians and support staff offer comprehensive and coordinated care in radiation oncology, urology, medical oncology, hematology, diagnostics, ENT and surgical oncology. For more information, visit https://www.genesiscareus.com

GenesisCareis an Equal Opportunity Employer that is committed to diversity and inclusion.

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