Qué hará
- Work the A/R aging every day by bucket (31 to 60, 61 to 90, 91 to 120, over 120 days) and by payer, starting with the highest dollar value and the claims closest to an appeal deadline.
- Check claim status on payer portals and by phone (Availity, UnitedHealthcare, the Medicare contractor portals, state Medicaid portals) and record the reference number, the representative's name and the next step on every account.
- Read 835 remittances and denial letters, map CARC and RARC codes to a root cause, and route the fix: corrected claim (frequency code 7), reconsideration, formal appeal, or write-off with the reason.
- Write first- and second-level appeals with the medical record and the LCD, NCD or payer policy reference, and track every appeal to a decision.
- Spot underpayments against contracted rates and dispute them; identify payer trends (a new edit, a changed policy) and report them to the team lead the same week.
- Resolve coordination of benefits, timely filing and authorization denials, including retro-authorization requests where the payer allows them.
- Handle refund and recoupment requests correctly, including the Medicare overpayment rules.
- Produce a monthly A/R report per practice: days in A/R, percentage over 90 days, collections by payer and the top five denial reasons with what was done about each.
Qué necesitamos
- 7+ years of insurance A/R follow-up for professional claims, including at least three years of writing appeals.
- Strong knowledge of payer appeal processes and deadlines: Medicare redetermination levels, Medicaid timelines, commercial reconsideration windows.
- Comfortable on the phone with payer representatives for hours at a time: polite, exact and persistent.
- Able to read a contract fee schedule and an 835 file and tell quickly whether a claim was paid correctly.
- Experience with practice management systems and clearinghouses (Availity, Waystar, Tebra, eClinicalWorks, athenahealth or similar).
- Bachelor's degree (any field).
- Fluent English, written and spoken.
- Reliable internet, a quiet home office and the ability to work United States business hours (Pacific Time).
- Pass a background check and sign a confidentiality agreement; HIPAA training is provided and refreshed yearly.
Deseable
No es obligatorio. Menciónelo si lo tiene.
- CPC, CPB or CRCR certification.
- Experience with Medicare Advantage and managed Medicaid plans.
- Experience with behavioral health, physical therapy or surgical specialties.
- Spreadsheet skills: pivot tables for aging and payer analysis.
Qué ofrecemos
- Salary on the United States pay scale, deposited twice a week, negotiable with experience.
- Full time, remote, United States business hours (Pacific Time, Monday to Friday).
- Paid time off and paid United States holidays.
- Training on the Revelrex EHR and on our billing playbooks during your first two weeks.
- A growth path into denial management lead or client-facing account management.
Cómo contratamos
- 1Postule en línea
Complete el formulario breve y adjunte su CV. Recibe un correo de confirmación de inmediato y una respuesta de una persona en un plazo de diez días hábiles.
- 2Una llamada de 20 minutos
Una videollamada con el líder del equipo sobre su experiencia: los sistemas que ha usado, los pagadores que conoce y cómo organiza su día.
- 3Un ejercicio práctico
Una tarea breve y realista en nuestro EHR de capacitación con pacientes sintéticos: por ejemplo, trabajar cinco denegaciones o verificar tres elegibilidades. Alrededor de una hora; nos fijamos en cómo piensa, no en la velocidad.
- 4Una oferta
Si encaja para ambas partes, recibe una oferta por escrito, una fecha de inicio y un plan de incorporación de dos semanas. Todo el proceso toma de dos a tres semanas.
Toda oferta está sujeta a una verificación de antecedentes y a la firma de un acuerdo de confidencialidad. Revelrex considera a las personas candidatas sin distinción de raza, color, religión, sexo, origen nacional, edad, discapacidad ni ninguna otra condición protegida.
Acerca de Revelrex
Revelrex es una empresa de gestión del ciclo de ingresos en Jefferson City, Misuri, que atiende consultorios independientes en todo Estados Unidos: facturación médica, gestión de denegaciones, acreditación, reconocimiento PCMH y el Revelrex EHR. Cumple con HIPAA y con SOC 2. Más sobre nosotros