Payment Recovery Specialist is responsible for analysis of denied reimbursement claims. Ensures appropriate insurance coverage for compliance standards and revenue generation. Being a Payment Recovery Specialist monitors, evaluates, and reviews all cost reporting in support of claims. Coordinates with departments and insurance companies to correct errors as necessary. Additionally, Payment Recovery Specialist requires a bachelor's degree in area of specialty. Typically reports to a supervisor or manager. To be a Payment Recovery Specialist typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
POSITION SUMMARY:
This position is responsible for maintaining claims data quality through ongoing quality review and assessment of medical records to ensure appropriate procedures were received. Perform concurrent audits on accuracy of DRG, OPPS, PPS and MPFS payment logic rules. Document findings on reports and identified trends to further evaluate appropriate payment logic is built within the system as well as review post-payment claims that have been identified. Work with the team to help document ways to improve processes for identified risks.
QUALIFICATIONS:
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0 Payment Recovery Specialist jobs found in Daytona Beach, FL area