What are the responsibilities and job description for the Revenue Recovery Specialist position at Mount Nittany Health?
POSITION SUMMARY
The Revenue Recovery Specialist is responsible for identifying and resolving underpayments and reimbursement variances through detailed account-level review and payer follow-up. This role ensures reimbursement aligns with contractual terms and expected payment methodologies, with a focus on maximizing net revenue recovery.
This position performs work primarily within Epic, utilizing variance payment work queues and reporting tools to identify accounts with potential underpayments. The Specialist validates payments, initiates recovery efforts, and resolves discrepancies through structured workflows.
While this role does not own denial management, it plays a key role in identifying trends and collaborating with Patient Accounts to address recurring issues.
This position is execution-focused and partners closely with the Revenue Recovery Analyst and Reimbursement team by escalating patterns, payer behaviors, and system issues identified through daily account work.
MINIMUM REQUIREMENTS
Education:
Associate’s Degree required
Bachelor’s preferred
Experience:
2 years experience in Revenue Cycle operations preferred, Healthcare industry, or similar background preferred
Experience working in an EHR or billing system, Epic strongly preferred
Knowledge, Skills, Abilities:
Strong understanding of claim payment workflows and payer behavior preferred
Strong attention to detail and persistence in follow-up
Experience working Epic work queues or similar system-driven workflows
Experience identifying and resolving underpayments
Familiarity with payer reimbursement methodologies or contract terms
Experience working with payer portals and payment review processes
Basic Excel skills for tracking and documentation
License/Certification/Registration:
None required
SUPERVISION RECEIVED
Receives general supervision from the Manager, Reimbursement.
SUPERVISION GIVEN
None
ESSENTIAL FUNCTIONS
Epic Work queues & Account Review
Monitors and works Epic variance payment work queues to identify underpayments and reimbursement discrepancies
Utilizes Epic reports and tools to prioritize accounts based on dollar value, payer, and recovery opportunity
Reviews claim-level detail within Epic to validate expected vs. actual reimbursement
Underpayment Identification & Reimbursement Validation
Validates expected reimbursement against actual payment using contract terms, fee schedules, and internal tools
Identifies payment variances including:
Incorrect rate application
Partial or missing payments
Bundling discrepancies
Modifier-related payment issues
Ensures alignment with payer contracts and reimbursement methodologies
Recovery Execution & Payer Follow-Up
Initiates and manages recovery efforts for underpaid claims through payer follow-up (payer portals, phone, written communication)
Submits reconsiderations or payment disputes as appropriate to resolve underpayments
Tracks recovery status and performs timely follow-up to maximize reimbursement
Trend Identification & Escalation
Identifies recurring issues across Epic work queues and account activity (payer-specific, CPT/DRG-specific, or department-specific)
Escalates trends and supporting examples to Revenue Recovery Analyst and leadership
Contributes to root cause identification and broader reimbursement improvement efforts
Collaboration with Patient Accounts
Partners with Patient Accounts to communicate trends or issues impacting reimbursement identified through Epic work queues
Provides detailed account examples to support investigation and resolution
Supports coordinated efforts to address upstream and downstream revenue cycle issues
Documentation & Tracking
Maintains detailed documentation of:
Accounts reviewed
Recovery actions taken
Dollars recovered
Ensures accurate Epic account notes and tracking logs for reporting and audit purposes
Cross-Functional Collaboration
NON-ESSENTIAL FUNCTIONS
Performs related and miscellaneous duties as assigned.