Experience identifying and resolving underpayments and overpayments across government and commercial payers, including performing detailed account reviews comparing expected versus actual reimbursement.
Strong analytical and reporting skills to monitor reimbursement performance by payer and service line, and to perform population-level analyses and root cause investigations.
Knowledge of payer reimbursement policies and contract terms, with attention to HIPAA/compliance and willingness to complete required trainings (e.g., CPR, OSHA, HIPAA).
Ability to work independently and within a team, manage multiple projects, and maintain confidentiality.
Requirements:
Identify and resolve underpayments and overpayments across government and commercial payers; perform detailed account reviews comparing expected vs actual reimbursement.
Initiate and manage payer appeals and refund processes; track and document recovery activity, outcomes, and aging.
Perform population-level analysis to identify systemic payment issues and emerging trends; conduct root cause analysis and collaborate with leadership to implement corrective actions.
Monitor payer compliance with contractual reimbursement terms and identify opportunities for process improvements and automation.
Job description
POSITION: Revenue Recovery Analyst
RESPONSIBLE TO: Director of Revenue Cycle Management
JOB SUMMARY: The Revenue Recovery Analyst is responsible for identifying, analyzing, and resolving discrepancies in insurance payments to ensure accurate reimbursement and maintain the organization's revenue integrity objectives. This role involves both targeted recovery initiatives for specific accounts and comprehensive analytics at the population level to detect patterns of underpayment and overpayment, ensure compliance with contracts, and facilitate proactive measures to prevent revenue loss.
RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
Identify and resolve underpayments and overpayments across government and commercial payers.
Perform detailed account reviews comparing expected vs. actual reimbursement.
Initiate and manage payer appeals and refund processes in accordance with regulatory requirements.
Track and document recovery activity, outcomes, and aging.
Escalate complex payer issues to RCM leadership as appropriate.
Ensure timely and compliant resolution of payment discrepancies.
Monitor payer reimbursement policies, bulletins, and payment methodology updates to identify potential financial impact. Perform preliminary analysis and escalate material changes to reimbursement leadership for further evaluation and action.
Analytics, Trending & Root Cause:
Develop and maintain reports to monitor reimbursement performance by payer, service line, CPT/HCPCS
Perform population-level analysis to identify systemic payment issues and emerging trends.
Conduct root cause analysis and collaborate with Director of Revenue Cycle Management, Managed Care Contracting, and Practice Operations to implement corrective actions.
Assess revenue at risk and potential recovery opportunities.
Monitor payer compliance with contractual reimbursement terms.
Identify opportunities for process improvement and automation.
OTHER
Ability to work independently and as part of a team with the capability to shift between projects while maintaining productivity and efficiency.
Attend Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.
Maintain patient confidentiality, comply with HIPAA and compliance guidelines established by the practice to protect RCM operations by keeping information confidential.
Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
Attend all meetings as requested, including regular staff meetings.
Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP Ethics Point hotline.
Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies.
