Revenue Recovery Analyst

This is an on-site position

The Revenue Recovery Analyst identifies, collects, and determines root causes of underpayment. Maintaining strong internal controls over billing processes and root cause analysis relating to all recovery efforts. This position is responsible for reviewing large amounts of remittance data, conduct analysis utilizing databases and modeling tools to identify areas of payment variances, to identify revenue optimization opportunities, and to take steps (appeals, corrected claims, etc.) to solve and capture the contractual underpayments.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Negotiation and personal computer (spreadsheet, database, word processor) skills, contract analysis, knowledge of claims adjudication process and effective communication and presentation skills.
• Thorough understanding of reimbursement methodologies as they relate to managed care contracting is also required.
• Basic understanding of medical care and medical terminology preferred
• Ability to write and perform basic MS SQL queries

Required Experience

Required:

• Bachelor’s degree in one of the following areas: Business administration, accounting, finance or healthcare management OR equivalent education/experience in the managed care/healthcare field.
• Previous experience in HMO or IPA environment.
• Knowledge of compliance issues as they relate to claims processing.
• Ability to successfully communicate with payors including insurance companies, health plans, and medical groups.
• Strong follow-up skills and time management; knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills and collaborative skills to uncover and recover payment discrepancy.
• MS SQL/MS Access experiences

Preferred:

• Basic understanding of medical care and medical terminology preferred
• Knowledge of payor guidelines, industry billing and coding standards and denials reason codes
• Data analyst experiences