Revenue Recovery Specialist, Clinical Denials

Are you seeking an exciting opportunity to join a passionate, growing, and dynamic team of professionals who support patients?

A Specialist I, Revenue Recovery Clinical Denials effectively and consistently generates revenue through professional billing practices, using proper and ethical collection efforts. Knowtion Health works as an ambassador on behalf of patients to resolve outstanding hospital bills and never collects monies from patients. This Specialist must be able to multi-task, prioritize as necessary to timely resolve accounts for payment, and maintain a high level of professionalism when communicating with payers and patients daily. In addition to drafting appeals, Specialists must demonstrate proficient use of web-based client and payer portals along with notation databases.

• Knowtion Health is a growing firm in a growing industry. Our status as a leader in this industry means that we have the resources to invest in the business and to innovate.
• Our business is intensely competitive and is constantly evolving. We quickly identify new challenges and develop solutions, so you will not simply be doing what was done last year. Our new employees are frequently pleased and surprised by how quickly we make decisions and adapt to market conditions.
• Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact.

• Using the Artiva workflow management system, follow up on patient bills and claims to recover revenue from the responsible business entity. Depending on the department, the business entities may include any or all the following: commercial health insurance, governmental insurance, veteran’s benefits, third party administrators, attorneys, motor vehicle carriers, employers and worker’s compensation carriers
• Analyze information to identify root cause of denied or unpaid claim and determine next steps
• Pursue & obtain information needed to overturn claim denials, including patient & responsible party information, medical necessity, employer information, accident information
• Ensure appropriate timely filing guidelines are met for maximum reimbursement
• Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively
• Identify and discuss root cause issues with management
• Consequence to errors in judgment are critical (HIPAA violation penalties, lost revenue for hospital client, other penalties, or fines)

• Minimum 1 year of experience drafting and submitting appeals with supporting documentation to overturn claims denials required.
• A high level of professionalism
• Adherence to all debt collection rules and regulations
• Adherence to HIPAA requirements
• Moderate computer proficiency including working knowledge of MS Excel, Word, and Outlook
• Organization and documentation skills to ensure timely follow-up and accurate record keeping
• Mathematical ability to calculate rates using addition, subtraction, multiplication, and division
• Familiarity with CPT, ICD coding preferred

The above statements are intended to provide the general nature and level of work being performed by most people assigned to the position. They are not intended to be an exhaustive list of all responsibilities, duties and requirements.

This position is remote and requires a dedicated, distraction-free work space at home. We offer a competitive benefits package including medical, dental, vision, life insurance, short term disability, long term disability, bonus opportunities, paid holidays, 401k, and a generous PTO policy.

Knowtion Health gives priority to applicants located in the following states: AL, AR, AZ, FL, GA, ID, IN, KS, ME, MI, MO, MS, NC, NM, OK, PA, SC, TN, TX, VA, WI, WV

As part of our hiring process, candidates are required to present a valid government-issued photo ID during screening and/or interviews.

We may also capture a photograph during the screening or interview process for identity verification, security, and record-keeping purposes. All identification documents and images will be handled in accordance with applicable privacy laws and accessed only by authorized personnel.

By proceeding with your application, you acknowledge and consent to this process.