Revecore logo
Revecore

Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.

Operations Specialist

Location

United States

Posted

3 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Operations Specialist

Revecore

Role Description As an Operations Specialist at Revecore, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. In this role you will leverage subject matter expertise to improve the accuracy, quality and prioritization of claims delivered to our analyst worklists. Each day may look a little different as you balance the various responsibilities of supporting your team; however, a portion of your time will be reserved to test and provide insights on new AI models that will improve results for your team, for Revecore and our Clients. Responsibilities - Provide training and onboarding support to new analysts as outlined in the Training and Development Onboarding programs. - Provide assistance to address analysts' technical questions and needs on claims handling. - Participate in the quality assurance process for the department, ensuring all applicable guidelines/deadlines are successfully achieved. - May review and approve adjustments on claims, up to a predetermined amount. - Review claims associated with new AI models that will drive improvements in the assignment and prioritization of claims in the future. - Utilize subject matter expertise to research and identify new underpayment opportunities outside of technology enabled worklists. - Investigate reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, or incorrect application of payer policies. - Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization. - Actively participate in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes. - Demonstrate a commitment to upholding ethical standards and compliance with relevant regulations and guidelines in all reimbursement optimization activities. Qualifications - High school diploma or equivalent required. Requirements - Want to grow a career. - Have moderate working knowledge of Microsoft Office (Word, Excel, Outlook). - Possess technical proficiency to work on multiple computer screens and software applications simultaneously. - Can maintain strong performance in a fast-paced environment with productivity metrics. - Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies. - Have a working knowledge of healthcare billing, coding, and reimbursement methodologies. - Can navigate and interpret various payer policies, including Medicare, Medicaid, and Commercial insurance guidelines. - Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech). - Have familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements. - Excellent verbal and written communication skills to convey complex information to individuals with minimal healthcare or claims background. Benefits - Competitive compensation with eligibility for a quarterly bonus. - Comprehensive medical, dental, vision, and life insurance benefits from day 1. - 12 paid holidays and flexible paid time off. - 401(k) with company match. - Employee Resource Groups that build community. - Career growth opportunities. - An excellent work/life balance. Work at Home Requirements - A quiet, distraction-free environment to work from in your home. - A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required. - The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check.

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