Job Title: Revenue Recovery Analyst

COMPANY OVERVIEW

Cloudmed is a first-of-its-kind, single-source enterprise platform provider of Revenue Intelligence™ solutions for hospitals. Cloudmed’s approach of combining human expertise with advanced technology utilizing machine learning algorithms provides a smarter, more predictive way for clients to realize all potential revenue. Today, Cloudmed partners with over 3,100 healthcare providers in the United States and recovers over $1.2 billion of underpaid or unidentified revenue for clients annually. Cloudmed (Triage solution) is the 2020 Revenue Integrity and Underpayment Services KLAS® Category Leader and its solution suites have HFMA Peer Review status and are HITRUST certified.

RESPONSIBILITIES

The A/R Revenue Recovery Analyst I is responsible for the appropriate management of assigned accounts. Responsibilities include calling insurance companies to resolve authorization and claim denials, writing appeals and letters to insurance companies to resolve denials, and following up on appeals to the point of exhaustion or payment.

Essential Duties and Responsibilities

• This is not an inclusive list. Other duties may be assigned

• Resolve, call and/or appeal a defined number of accounts per day as instructed by leadership.
• Complete Initial Reviews and Validations as assigned.
• Draft appeals and letters to insurance companies.
• Calculate expected claim reimbursement.
• Make proper notations in software system on all accounts.
• Understand and utilize payer contracts and provider manuals when disputing denials.
• Use proper approved note structure when notating all accounts.
  • Insurance company name @ number dialed | First name and last initial of the representative spoken to. (Ex. Aetna @ 1-800-624-0756 | John S.)
• Follow up on all appeals, claims, letters, or other documentation within 20 days or less of the submission.
• Follow up on all payments at the time an overturn is received.
• Demonstrate an understanding of office workflow by completing necessary required fields correctly.
• Use available resources appropriately, including but not limited to training materials, shared drive, team meeting notes, etc.
• Ensure that assigned accounts are appealed timely using an internal worklist.
• Maintain worklist through daily audits and the open task report.
• Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.
• Address all follow ups promptly.
  • Alerts must be addressed within a day of receipt.
  • Initial call requests must be addressed within two days from the receipt of the follow up.
  • Follow ups should never be more than 14 days old.
• Handle RUSH cases appropriately.
  • A RUSH is any appeal or submission that is due within two weeks from the date the due date was verified.
• Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist.
• Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility.
• Follow all HIPAA guidelines in accordance with Employee Handbook.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Bachelor's degree from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.

Computer Skills

To perform this job successfully, an individual should have knowledge of internet software, spreadsheet software and word processing software.

CULTURE FIT

The culture at Cloudmed 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!

BENEFITS

Cloudmed provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.

BEING YOU @ CLOUDMED

Cloudmed recruits, employs, trains, compensates, and promotes regardless of race, religion, color, national origin, sex, disability, age, veteran status, and other protected statuses. At Cloudmed, we have a clear vision: to be a place where a diverse mix of talented people feel supported and empowered to reach their full potential. We pride ourselves on delivering premium results and client service to all our hospital clients. Cloudmed runs on the hard work and dedication of our passionate and diverse employees.

Cloudmed is an Equal Opportunity Employer