RCM Revenue Recovery Analyst

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    "jobTitle": "RCM Revenue Recovery Analyst",
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    "description": "<h2 style=\"margin-top:3px;margin-left:7px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><b>POSITION: </b>Revenue Recovery Analyst</span></span></h2>\n\n<h2 style=\"margin-left:7px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><b>RESPONSIBLE TO: </b>Director of Revenue Cycle Management </span></span></h2>\n\n<h2 class=\"MsoBodyText\" style=\"margin-right:19px;margin-left:7px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><b>JOB SUMMARY: </b>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.</span></span></h2>\n\n<h2 class=\"MsoBodyText\" style=\"margin-right:19px;margin-left:7px;\"> </h2>\n\n<h2 style=\"margin-left:7px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\">RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:</span></span></h2>\n\n<ul>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:normal;\"><span style=\"color:#000000;\">Identify and resolve underpayments and overpayments across government and commercial payers.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Perform detailed account reviews comparing expected vs. actual reimbursement.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Initiate and manage payer appeals and refund processes in accordance with regulatory requirements.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Track and document recovery activity, outcomes, and aging.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Escalate complex payer issues to RCM leadership as appropriate.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Ensure timely and compliant resolution of payment discrepancies.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">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.</span></span></span></span></span></h2>\n\t</li>\n</ul>\n\n<h2 style=\"margin-left:8px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><b><span style=\"color:#000000;\">Analytics, Trending &amp; Root Cause:</span></b></span></span></span></h2>\n\n<ul>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Develop and maintain reports to monitor reimbursement performance by payer, service line, CPT/HCPCS</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Perform population-level analysis to identify systemic payment issues and emerging trends.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Conduct root cause analysis and collaborate with Director of Revenue Cycle Management, Managed Care Contracting, and Practice Operations to implement corrective actions.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Assess revenue at risk and potential recovery opportunities.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Monitor payer compliance with contractual reimbursement terms.</span></span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:56px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"background:#FFFFFF;\"><span style=\"line-height:15.25pt;\"><span style=\"color:#000000;\">Identify opportunities for process improvement and automation.</span></span></span></span></span></h2>\n\t</li>\n</ul>\n\n<h2 style=\"margin-left:7px;\"><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\">OTHER</span></span></h2>\n\n<ul style=\"margin-top:12px;\">\n\t<li style=\"margin-top:12px;margin-right:13px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:15.25pt;\">Ability to work independently and as part of a team with the capability to shift   between projects while maintaining productivity and efficiency.</span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:36px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:100%;\"><span style=\"line-height:100%;\">Attend Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.</span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:69px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:15.25pt;\">Maintain patient confidentiality, comply with HIPAA and compliance guidelines established by the practice to protect RCM operations by keeping information confidential.</span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:10px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:100%;\"><span style=\"line-height:100%;\">Maintains detailed knowledge of practice management and other computer software as it relates to job functions.</span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:15.05pt;\">Attend all meetings as requested, including regular staff meetings.</span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:12px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:100%;\"><span style=\"line-height:100%;\">Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.</span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:40px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:15.25pt;\">Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance &amp; Privacy or via the AP Ethics Point hotline.</span></span></span></h2>\n\t</li>\n\t<li style=\"margin-right:11px;margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:100%;\"><span style=\"line-height:100%;\">Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies.</span></span></span></span></h2>\n\t</li>\n\t<li style=\"margin-left:8px;\">\n\t<h2><span style=\"font-size:12px;\"><span style=\"font-family:Arial, Helvetica, sans-serif;\"><span style=\"line-height:15.05pt;\">All other projects and duties as assigned.</span></span></span></h2>\n\t</li>\n</ul>",
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Position requires prolonged sitting, some bending, stooping, and stretching. Good eye - hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.\",\"responsibilities\":\"POSITION: Revenue Recovery Analyst\\n\\nRESPONSIBLE TO: Director of Revenue Cycle Management \\n\\nJOB 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. 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Position requires prolonged sitting, some bending, stooping, and stretching. Good eye - hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. 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Position requires prolonged sitting, some bending, stooping, and stretching. Good eye - hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.\",\"validThrough\":\"-0001-11-30\"}",
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