Revenue Recovery Specialist

The Revenue Recovery Specialist is responsible for all aspects of billing and collection of funds for services provided to residents and patients in life plan communities that are paid for directly by the patient, resident, family member, or appointed guardian in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

• Maintain, obtain, retain, and apply knowledge regarding the specific billing requirements established by management applicable for private pay billing to and collections from residents/patients of the Communities' independent living, assisted living, skilled nursing, outpatient, or other ancillary service settings. This includes developing and maintaining working knowledge of the primary revenue, receivables, receipts, billing, and medical records software to enable efficient and effective use.
• Complete all routine daily and monthly processes pertaining to census verification and validation. Interact with site representatives to clarify and/or correct any census discrepancies.
• Perform certain tasks pertaining to monitoring status of level of care approval/denial by local area offices of aging, Medicaid application approval/denial by County Offices of Medicaid, and receipt of all required documentation to enable Medicaid billing to occur. This includes frequent interaction with Communities' site representatives, patients or their family members and/or guardians, and governmental agency representatives. Maintain quality documentation of interaction with site and patient/resident or their representatives within the notes section of the primary software.
• Perform certain tasks relating to verifying patient liability amounts (e.g., personal funds available) for Medicaid beneficiary patients/residents at prescribed timing.
• Review and balance all assigned ancillary service files provided by various vendors by the prescribed dates for the month end close billing cycle to ensure all ancillary services are captured in billing files to enable accurate claims.
• Ensure that all required documents are included into the electronic medical record within prescribed timelines. This includes approved Cost of Care packets, approved Life Care Application packets, consummated Residency Agreements, and certain other documents as applicable.
• Monitor status of collections and appropriate cash receipt application to correct resident and patient account balances. This includes receipt of explanation of benefits from primary or secondary health insurance coverage (e.g., Medicare, managed care plans, etc.), to enable the identification of coinsurance that should be included on the current month end close private pay invoice statements.
• Prepare, review, and release private pay invoice statements, using specified software, within established monthly billing performance timeframe and by prescribed due dates. Invoice statements should be completely accurate with minimal and infrequent errors subsequently discovered. Adhere to supervisory internal control review requirements before release of claims. Established supporting documents or special statement inserts must be included in the mailing.
• Identify and escalate significant site performance, ancillary vendor data performance, or contested invoice accuracy issues to supervisor/manager in a timely manner.
• Field incoming patient, resident, and/or appropriate family member or guardian calls or emails in a professional and responsive manner. Perform appropriate account research and activity verification. Develop thoughtful and accurate response and send to inquirer. Escalate more complex matters to supervisor/manager when appropriate.
• Review accounts receivable aging reports to identify outstanding balances and take appropriate action to research and resolve outstanding balances. Goals for overall days in accounts receivable, targeted outstanding balances needing resolution, and expecting timing will be established on a monthly basis by supervisor/manager.
• Make collection calls at prescribed intervals. Prepare and send collection letters at prescribed intervals. Develop payment plan options when appropriate and within prescribed guidelines. Refer certain accounts to attorneys or collection agency upon supervisor/manager approval.
• Review accounts receivable aging reports on a prescribed timing frequency such that refunds can be identified, verified, and paid on a reasonably timely basis. Identify appropriate party for which refunds should be made.
• Process refundable entrance fee refunds as approved by site and other corporate management representatives. Identify appropriate party for which refunds should be made.

• Excellent communication and interpersonal skills
• Ability to maintain confidentiality and handle sensitive information
• Strong organizational and time management skills
• Proficiency in Microsoft Office and ability to learn new software applications
• Experience in revenue recovery, customer service, or related field preferred

• Career growth opportunities
• Competitive salary and benefits package
• Professional development training and support

• Contribute to a dynamic and supportive team environment
• Pursue ongoing education and training to stay up-to-date on industry trends and best practices