Revenue Recovery Specialist (work comp)

The WC Revenue Recovery Specialist is responsible for identifying, investigating, and pursuing reimbursement discrepancies and underpayments related to workers' compensation claims. This role works collaboratively with the Work Comp, Revenue Cycle, and Finance teams to maximize reimbursement, improve revenue integrity, and support payer accountability.

Key Responsibilities:

• Maintains underpaid account inventory ensuring active and current follow-up via the WC worklist.
• Maintain communication with leadership to obtain needed documentation to properly pursue underpayments and achieve collection recovery if applicable.
• Collaborate with the appropriate staff regarding contract and payer practice issues in order to improve revenue integrity
• Analyze and report payer reimbursement and underpayment trends.
• Generate and analyze reports to identify reimbursement opportunities and monitor recovery performance.
• Collaborate with payers, vendors, and internal stakeholders regarding reimbursement disputes and negotiated payment resolutions.
• Provides support to the work comp and revenue cycle team, including relaying messages and correspondences from defined payers.
• Communicate with adjusters, carriers, attorneys, employers, and other stakeholders via phone, email, fax, and written correspondence regarding reimbursement discrepancies.
• Perform payment audits on high-dollar workers' compensation claims.
• Monitor compliance with payer contracts and reimbursement expectations.
• Document recovery efforts within the WC Worklist.
• Prepare summaries and recommendations for leadership regarding payer performance.
• Assist in identifying contract improvement opportunities and reimbursement trends.
• Maintain a highly responsible and confidential nature
• Assist with other duties as assigned

• High school diploma with four years of accounts receivable/insurance experience – or –
• Associates Degree in Business or Insurance with two years of medical billing and/or insurance experience required
• Possession of the ability to maintain composure when confronted with fast paced and stressful situations
• Knowledge of medical records and practice management computer systems (Currently: NextGen)
• Excellent communication skills
• Customer Service Skills by phone and e-mail
• Math skills to add, subtract, multiply and divide
• Basic computer skills; Microsoft Office Suite (Excel, outlook, word, etc)
• Ability to enter data into systems with minimal errors
• Medical Terminology and Medical Forms experience preferred but not required
• Working knowledge of CPT, HCPCS, ICD-10, medical billing practices, and reimbursement methodologies.
• Ability to utilize web tools, fee schedules, and contracts to work accounts efficiently and timely
• Ability to prioritize and demonstrated ability to manage details
• Ability to maintain composure during times of change or job assignments

Preferred:

• Experience with workers' compensation reimbursement methodologies and contract analysis.
• Experience appealing underpaid or denied claims.
• Experience negotiating reimbursement disputes with carriers or third-party administrators

Why Choose Iowa Ortho?

At Iowa Ortho, we are guided by our IMPACT values, and we believe in fostering a culture that prioritizes both professional excellence and compassionate care:

• Innovation that Drives Positive Outcomes (I)
• Motivation for Exceptional Care (M)
• Passion for Quality in Everything We Do (P)
• Accountability Through Open and Honest Communication (A)
• Commitment to Continued Growth (C)
• Teamwork (T)

• Competitive Benefit Package: Competitive pay, health, dental, 160hrs paid time off, paid holidays, 401(k) with company match, profit-sharing, employee discounts and more.
• Center of Excellence: Physician-owned orthopedic clinic and surgery center dedicated to providing exceptional medical care      to the people of central Iowa. Discover why Iowa Ortho is a recognized center of excellence in orthopedic care.
• Cutting-Edge Environment: Work in a state-of-the-art facility that embraces the latest advancements in medical technology.
• Team Atmosphere: Join a collaborative team that supports one another and is committed to enhancing patient care.
• Professional Growth: Opportunities for career advancement and continuous learning.