Medicare Analyst

Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, 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. Revecore Perks: We offer paid training and incentive plans Our medical, dental, vision, and life insurance benefits are available from the first day of employment We enjoy excellent work/life balance Our Employee Resource Groups build community and foster a culture of belonging and inclusion We match 401(k) contributions We offer career growth opportunities We celebrate 12 paid holidays and generous paid time off Location: Remote — USA The Role: TDRG (Medicare) Analyst 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 and 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 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. Is this role for you? Revecore encourages our employees to be driven and highly motivated to be successful. We get excited by candidates who: Want to grow a career Have a 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 CMS and Medicare Advantage 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. How we’ll set you up for success: Extensive multi-week training with ongoing support from teammates following training. Access to a robust knowledgebase for continued reference in your role. Visibility to your individual performance metrics enables you to set goals. Computers and necessary work equipment are provided Involved management who leans in to support your productivity metrics. Work at Home 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. Revecore is an equal opportunity employer that does not discriminate on the basis of race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status. We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply. Must reside in the United States within one of the states listed below: Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia. #LI-DNI