Revenue Recovery Specialist – Clinical Denials

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Knowtion Health

501 - 1000 employees

Founded 2008

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

💰 Private Equity Round on 2020-09

Healthcare Insurance • Fintech • SaaS

Knowtion Health is a company that assists hospitals in handling denied and complex claims, recovering low balance accounts, and providing defense against payer audits. By leveraging advanced technology and a team of experts, Knowtion Health aims to maximize revenue and improve patient experiences. Their services include addressing clinical denials and managing various challenging payer classes, positioning them as a strong advocate for their clients in the healthcare sector.

📋 Description

• 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, and third party administrators • 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 • Draft and submit appeals with supporting documentation to overturn claim denials • Consequence to errors in judgment are critical (HIPAA violation penalties, lost revenue for hospital client, other penalties, or fines)

🎯 Requirements

• 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

🏖️ Benefits

• medical • dental • vision • life insurance • short term disability • long term disability • bonus opportunities • paid holidays • 401k • generous PTO policy

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