Revenue Recovery Analyst

POSITION SUMMARY

The Revenue Recovery Analyst is responsible for identifying, analyzing, and resolving hospital and physician payment variances to ensure accurate reimbursement and support enterprise revenue integrity objectives. This role performs both account-level recovery activities and population-level analytics to detect underpayment and overpayment trends, validate contract compliance, and support proactive mitigation of revenue leakage.

The Analyst partners closely with the Manager of Reimbursement, Revenue Integrity, Patient Accounts, and Finance to support expected reimbursement accuracy, payer performance monitoring, and root cause remediation. This position plays a key role in preparing the organization for Epic expected reimbursement functionality and advancing data-driven reimbursement strategy.

MINIMUM REQUIREMENTS

Education:

Experience:

Knowledge, Skills, Abilities:

• Strong understanding of hospital and outpatient reimbursement methodologies
• Ability to interpret payer contracts and remittance advice
• Advanced analytical and problem-solving skills
• Proficiency in Excel (pivot tables, lookups, data analysis)
• Experience with revenue cycle systems (Meditech, Epic, Quadax, or similar) preferred
• Knowledge of UB-04 and/or CMS-1500 claim structure preferred
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities and meet deadlines
• Effective written and verbal communication skills
• Ability to work both independently and collaboratively
• Knowledge of CPT and HCPCS codes preferred.

License/Certification/Registration:

None required

SUPERVISION RECEIVED

Receives primary supervision from the Manager Reimbursement under the leadership of Director of Revenue Integrity & Reimbursement Strategy.

SUPERVISION GIVEN

None

ESSENTIAL FUNCTIONS

Payment Variance Identification & Recovery

• Identify and resolve underpayments and overpayments across government and commercial payers
• Perform detailed account reviews comparing expected vs. actual reimbursement
• Initiate and manage payer appeals and refund processes in accordance with regulatory requirements
• Track and document recovery activity, outcomes, and aging
• Escalate complex payer issues to Manager of Reimbursement as appropriate
• Ensure timely and compliant resolution of payment discrepancies
• 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.

Analytics, Trending & Root Cause

• Develop and maintain reports to monitor reimbursement performance by payer, service line, CPT/HCPCS, and DRG
• Perform population-level analysis to identify systemic payment issues and emerging trends
• Conduct root cause analysis and partner with Revenue Integrity, Patient Accounts, and Contracting to implement corrective actions
• Quantify revenue at risk and recovery opportunities
• Monitor payer compliance with contractual reimbursement terms
• Identify opportunities for process improvement and automation

Expected Reimbursement & Contract Support

• Support validation of expected reimbursement models and payer payment logic
• Assist in maintaining payer rate tables and reimbursement assumptions
• Provide data support for payer discussions and dispute resolution
• Assist with Epic expected reimbursement readiness and ongoing optimization

Reporting & Collaboration

• Prepare recurring and ad hoc reports for reimbursement leadership
• Communicate trends and risks to Manager of Reimbursement and Director of Revenue Integrity & Reimbursement Strategy
• Collaborate with Revenue Integrity, Patient Access, Coding, and Patient Accounts to resolve upstream and downstream issues
• Support development of dashboards and performance monitoring tools
• Participate in cross-functional initiatives to improve revenue cycle performance

Compliance & Regulatory

• Ensure adherence to payer contract terms and regulatory requirements
• Maintain compliance with Medicare, Medicaid, and commercial payer guidelines
• Support audit readiness and documentation standards
• Stay current on reimbursement rule changes and payer policy updates

NON-ESSENTIAL FUNCTIONS

Performs related and miscellaneous duties as assigned.