Website Revint Solutions
The Revint Solutions is looking for highly talented and motivated individuals for their Remote offices. If you are interested in the long-term career progression then apply for CLAIMS ANALYST II in Remote.
Job: CLAIMS ANALYST II
Company: Revint Solutions
Job Title: Claims Analyst II
For more than 20 years, Revint Solutions has been helping healthcare providers recover revenue and bolster their bottom lines. Revint Solutions’ recovery methodology and technology platforms work to optimize the revenue cycle. With the use of intelligent proprietary analytics, our recovery teams are truly the best and most experienced at finding and recovering lost or unidentified revenue. We take a holistic approach to revenue recovery and look at not only contract compliance, but also charge and revenue integrity as well as regulatory compliance such as Transfer DRG and DRG validation. Today, we serve over 1,600 hospitals and health systems nationwide and are proud of numerous awards and recognitions, including being consistently named one of the Best Places to Work both locally and nationally.
The Claims Analyst II has the primary role of validating and reviewing hospital accounts which are believed to have additional revenue opportunity. Accounts with underpayments are forwarded to the Claims Analyst II who will confirm claim reimbursement, ensure there are no additional variables impacting reimbursement, diagnose the root cause of the underpayment, and initiate the process of appeal with the payer.
The Claims Analyst II will work within the client’s Patient Accounting system, payer portals and/or websites, and will utilize Revint Solutions’ proprietary software to research accounts in the work queue.
Review underpaid claims, validate calculation of the expected reimbursement, and “re-price” claims as needed.
Determine action required to resolve the underpayment and initiate that action, including submitting appeals and reconsideration requests.
Document the account to provide information and details to support resolution analyst’s pursuit for additional reimbursement. Make notes in the client’s system to indicate ‘Revint’ activity.
Diagnose and understand how the underpayment occurred and what our client could have done to prevent it. This will require a basic understanding of the Hospital Revenue Cycle. These analyses are quantified and delivered to our client for process improvement, so it is of the utmost importance that the research is thorough and accurate.
Meet required benchmarks for accuracy and efficiency.
Once accuracy expectations are demonstrated/met, the Claims Analyst II will work independently to manage, approve and forward their own accounts.
The Claims Analyst II will utilize increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to train and QA the work of Claims Analyst I.
Claims Analyst II is expected to understand more complex payment methodologies (OPPS, APC-based pricing, multiple OP fee schedules).
High School graduate or Associate Degree required
1 – 2 years of experience with data mining, trending and auditing claims with accuracy expectations met
Experience accessing facility/hospital patient accounting systems
Understanding and knowledge of medical terminology, claims billing, and inpatient and outpatient coding (e.g., MSDRG, ICD-10 diagnosis and procedure codes, CPT, HCPCS, etc.)
Experience and knowledge with inpatient and outpatient reimbursement methodologies as well as a familiarity with managed care contracts
Strong mathematical knowledge and ability to calculate complex equations
Must be a motivated, organized, and analytical individual with strong critical thinking skills and attention to detail
Must be diligent in communication – verbal and written communication to give specifics and details to support claims
Must present with strong computer skills
Must have a good understanding of Hospital Revenue Cycle
Bachelor’s Degree – preferred
The culture at Revint Solutions embraces those that demonstrate a deep passion for solving the problems of healthcare with enthusiasm for building positive working relationships and winning as a team. Take the work seriously, but don’t take yourself too seriously. Creating a strong workplace culture has been one of our staples, which we believe encourages and inspires employees to do their best. Join a fulfilling team of like-minded individuals who can get their work done, but still have fun!
Revint Solutions provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.
Revint Solutions is an Equal Opportunity Employer