Revenue Recovery Analyst

Anaheim Admin - Anaheim, CA

Full-time - Entry Level

Anaheim, CA

About the position

Planned Parenthood of Orange and San Bernardino Counties is seeking a dedicated Revenue Recovery Analyst to join our team in Anaheim, CA. This full-time position is critical to our Revenue Cycle Management (RCM) efforts, focusing on identifying, collecting, and analyzing underpaid claims. The Revenue Recovery Analyst will play a vital role in auditing payor performance and ensuring compliance with contractual agreements, which is essential for the operational integrity of our organization. In this role, the Revenue Recovery Analyst will conduct thorough investigations into payment variances, performing deep dives into the processing of claims across our facilities. The position will primarily address the resubmission, reprocessing, and correction of denied or rejected insurance claims, particularly those that are complex or involve high-volume facilities and top payors. This analytical role requires a keen eye for detail and the ability to navigate intricate claim issues effectively. The Revenue Recovery Analyst will also support the RCM collection team by providing training and handling escalated claim follow-ups. This includes compiling billing and payor documentation to create training materials, responding to payment discrepancies, and developing dashboards and reports on key performance indicators. The successful candidate will utilize independent judgment and discretion to ensure timely reviews and audits of underpaid claims, ultimately contributing to the financial health of our organization.

Responsibilities

• Utilize independent judgment and exercise discretion to ensure timely review and auditing of underpaid claims.
• Analyze, collect underpayments, and resolve claims with discrepancies from expected payment to ensure payors are in payment compliance with their contracted terms.
• Compile billing and payor documentation to create training documents.
• Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payor specific processes.
• Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third-party payors.
• Work directly with payor to recover payments.
• Quantify payor trends and maintain productivity and accuracy standards in a highly challenging environment.
• Prepare second-level appeals, recoveries, and potential settlements.
• Ability to extrapolate complex claims data and payer information to accurately report trends and payor behaviors.
• Develop dashboards and reports on key performance indicators, metrics, data points, and formulas to support management.

Requirements

• Strong analytical skills with the ability to interpret complex data and identify trends.
• Experience in revenue cycle management or healthcare billing and coding.
• Proficient in using billing software and electronic health record systems.
• Excellent communication skills, both written and verbal, to interact with payors and internal teams.
• Detail-oriented with strong organizational skills to manage multiple tasks and deadlines.

Nice-to-haves

• Knowledge of healthcare regulations and compliance standards.
• Experience with claims processing and appeals in a healthcare setting.
• Familiarity with data analysis tools and reporting software.

Benefits

• Medical, dental, and vision coverage for employees and eligible dependents.
• Life insurance and long-term disability coverage.
• Generous vacation, sick, and holiday benefits.
• 401(k) matching contributions.
• Benefits coverage starts after one full month of employment.