Role Summary: The Payment Recovery Specialist reviews claims to make sure that payer specific billing requirements are met, follows-up on billing through payment of the claim, answers inquiries, and updates accounts as necessary. The Payment Recovery Specialist is responsible for analysis of denied reimbursement claims and ensures appropriate insurance coverage for compliance standards and revenue generation. The Payment Recovery Specialist coordinates with departments and insurance companies to correct errors as necessary. Role Responsibilities:Resolves billed claims and referred denialsRuns reports to determine upcoming workloadPerforms initial contact (phone, web portal) with payers to validate claim status and reason for denial.Extracts data from client patient accounting system necessary to resolve denied claimsDocuments account activity in both the Human Arc and client operating system (posts, dispositions, notes, status, etc.)Sorts through and takes appropriate action on incoming client correspondence from insurance companiesRequests and obtains medical records from client or other documentation from physicians offices to resolve denied claimsRequests additional information as needed from clients, physicians and/or related providers and patients to resolve denied claimsIssues appeal letters on non-clinical denialsFollows up with patient for additional informationFollows up on all appeals, payments and denials, bringing accounts to resolution with both payer and clientCommunicates pertinent client and payer trends to the Team LeaderReview payment accuracy for final disposition of accountPerforms filing/scanning as needed on assigned accountsCommunicates pertinent client information regarding procedures, project status to Team LeaderAccountable for meeting established productivity measures and goalsParticipates in special projects as assignedRole Requirements:Knowledge of and experience with Hospital Patient Accounting systems; language, flow of work, processes, and proceduresStrong knowledge of insurance types and associated administrative guidelines for eachUnderstanding of hospital revenue cycle and insurance payment methodologiesBilling process and procedures (including parameters and requirements of billing)Electronic billing softwareUnderstanding of insurance contracts and terminologyKnowledge of State policies/procedures on determining eligibility and claims processingBasic understanding of appeals/denial resolution processing needsStrong communication skills and problem-solving abilityStrong analytical, project planning and organizational skills