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Role Description

As a TDRG (Medicare) Analyst at Revecore, you hold a pivotal position in ensuring hospitals receive accurate compensation for the services they provide. Your role involves:

• Examining hospital claims to verify proper reimbursement.
• Working with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies.

Training:

Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences.

As a TDRG (Medicare) Analyst, you will:

• Utilize company best practices along with technology-enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers.
• Capture lost revenue for hospitals by investigating patient's discharge status via calls to post-acute providers and insurance carriers.
• Contact insurance companies to obtain missing information, explain and resolve underpayments, and arrange for payment or adjustment processing on behalf of the client.
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports, and payment posting.
• 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

• Driven and highly motivated to be successful.
• Desire to grow a career.
• Working knowledge of Microsoft Office (Word, Excel, Outlook).
• Technical proficiency to work on multiple computer screens and software applications simultaneously.
• Strong performance in a fast-paced environment with productivity metrics.
• Strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies.
• Working knowledge of healthcare billing, coding, and reimbursement methodologies.
• Ability to navigate and interpret various payer policies, including CMS and Medicare Advantage insurance guidelines.
• Experience with healthcare billing software and databases (EPIC, Cerner, Meditech).
• Familiarity with legal and regulatory frameworks governing healthcare reimbursement, such as HIPAA, CMS regulations, and state-specific requirements.

Requirements

• A quiet, distraction-free environment to work from in your home.
• A secure internet connection is required.
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.

Benefits

• Paid training and incentive plans.
• Medical, dental, vision, and life insurance benefits available from the first day of employment.
• Excellent work/life balance.
• Employee Resource Groups build community and foster a culture of belonging and inclusion.
• 401(k) contributions matched.
• Career growth opportunities.
• 12 paid holidays and generous paid time off.