Apply on Employer Site

PIH Health · 1 day ago

Revenue Recovery Analyst

Whittier, CA

Full-time

Onsite

Mid Level

$69K/yr - $114K/yr

PIH Health is a nonprofit, regional healthcare network serving approximately 3 million residents in the Los Angeles County area. The Revenue Recovery Analyst is responsible for identifying underpayments, maintaining billing controls, and analyzing data to optimize revenue and resolve payment discrepancies.

Health Care

Responsibilities

Identify, collect, and determine root causes of underpayment

Maintain strong internal controls over billing processes and root cause analysis relating to all recovery efforts

Review large amounts of remittance data

Conduct analysis utilizing databases and modeling tools to identify areas of payment variances

Identify revenue optimization opportunities

Take steps (appeals, corrected claims, etc.) to solve and capture the contractual underpayments

Qualification

Claims adjudication knowledgeReimbursement methodologiesMS SQL queriesNegotiation skillsContract analysisData analysisBasic medical terminologyEffective communicationTime managementCollaborative skills

Required

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

Ability to write and perform basic MS SQL queries

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