Knowtion Health

Vice President

• Own strategy, performance, and financial accountability for Clinical Denials, Underpayments, and Interest & Penalties
• Lead denial review, audit, and appeal operations
• Ensure quality, timeliness, compliance, and overturn performance meet expectations
• Direct identification, validation, and recovery of payer underpayments
• Manage contract modeling, recovery targets, aging management, and escalation processes
• Lead Interest & Penalties recovery and ensure compliance with payer contracts, prompt-pay requirements, and healthcare regulations
• Build, mentor, and manage a high-performing leadership team
• Establish productivity, quality, and financial performance standards
• Partner with executive, clinical, coding, compliance, and delivery leaders
• Drive root-cause remediation, process and technology improvements, automation, and client delivery alignment
• Report to the Chief Delivery Officer

Senior Vice President, Delivery – Denials Resolution, Payment Compliance

General

• Analyze denied claims to determine underlying reasons for denial
• Conduct necessary follow-up actions, including preparing and submitting appeals with comprehensive documentation and justification
• Communicate with payors regarding unpaid or underpaid claims
• Resolve account denials and ensure timely, accurate recovery of outstanding claims
• Maintain accurate records of claim activities, appeals, follow-ups, and resolutions in Artiva and client systems
• Ensure compliance with regulations and guidelines governing claims processing and revenue recovery
• Meet timely filing guidelines to maximize reimbursement
• Identify recurring trends, issues, and process improvement opportunities
• Communicate insights and actionable recommendations to management
• Generate revenue through professional billing practices and proper, ethical collection efforts
• Resolve outstanding hospital bills on behalf of patients without collecting money directly from patients

Revenue Recovery Specialist II

• Manage an inventory from multiple clients with complex denials
• Work new and priority accounts within 48 business hours
• Work aged and high-dollar accounts to ensure efficient revenue cycle recovery
• Review accounts requiring substantive review by coding and utilization departments
• Identify and resolve denials to obtain timely payment for clients
• Prepare and submit appeals with required documentation
• Maintain clear, concise, and comprehensive notation throughout claim resolution
• Maintain professional relationships and communication with patients and payer representatives
• Learn and implement client-specific protocols and procedures
• Use web portals, client systems, and databases to document and resolve accounts
• Identify recent payer resolution trends and relay them to peers
• Communicate questions and concerns proactively to the supervisor

Revenue Recovery Specialist

Clinical Specialist

• Use the Artiva workflow management system to follow up on patient bills and claims and recover revenue from responsible business entities
• Analyze information to identify the root cause of denied or unpaid claims and determine next steps
• Pursue and obtain information needed to overturn claim denials, including patient and responsible-party information, medical necessity, employer information, and accident information
• Ensure timely filing guidelines are met for maximum reimbursement
• Escalate complex, complicated, or challenging accounts to management
• Identify and discuss root-cause issues with management
• Communicate professionally with payers and patients daily
• Draft appeals with supporting documentation
• Maintain accurate account notes and records

Revenue Recovery Specialist, Clinical Denials

Nurse

• Review medical record documentation to verify medical necessity issues related to length of stay, level of care, readmissions, experimental/investigational services, and similar matters
• Create detailed clinical analyses and appeal letters for payer denials to support payment of patient claims
• Manage inventory and follow up on accounts as appropriate
• Review InterQual/Milliman and/or payer medical policies related to denied procedures or services and include criteria in analyses and appeal letters as appropriate
• Provide feedback to the supervisor regarding issues identified for ongoing training of peers and non-clinical staff
• Identify root causes and trends to share with clients and staff
• Work with attorneys and claims representatives to review and appeal claims when appropriate to overturn clinical denials from Medicare, Medicaid, and other third-party payers

Nurse Specialist II, Clinical Denials

Learning and Development

• Create and review instructional design content and Training Team projects before submission to the Director of Training
• Audit training events for alignment with Knowtion Health and Training Team SOPs
• Provide feedback and recommendations for training improvement
• Conduct weekly 1:1s with direct reports
• Provide coaching and feedback
• Support employee development
• Retrieve and analyze class evaluations
• Recommend improvements to future training events
• Shadow each line of business on a rotating basis to align training content with operational needs
• Provide leadership coverage when the Training and QA Director and Assistant Director are absent
• Communicate issues proactively and support resolution

Team Leader II – Learning and Development

Project Manager

• Develop and manage comprehensive project plans aligned with client requirements and contractual statements of work
• Lead multiple concurrent client implementation projects
• Ensure timely progress and clear communication across internal and external stakeholders
• Monitor project milestones and task completion
• Identify risks proactively and implement mitigation strategies
• Build and maintain relationships with clients, stakeholders, and internal teams
• Position Knowtion Health as a trusted partner
• Track program success against booking estimates
• Report on key performance indicators