RCM Revenue Recovery Analyst

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. Work includes targeted recovery initiatives, population-level analytics to detect underpayment and overpayment patterns, compliance monitoring, and proactive revenue protection.

Responsibilities include resolving underpayments and overpayments across government and commercial payers, managing payer appeals and refund processes per regulatory standards, tracking recovery activity, escalating complex cases, and monitoring payer reimbursement policies. The role also involves developing reports to monitor reimbursement performance by payer, performing root cause analysis, collaborating on corrective actions, assessing revenue at risk, and identifying process improvements.

Additional duties include maintaining productivity across projects, attending Medicare and relevant continuing education, ensuring patient confidentiality and HIPAA compliance, and completing required training. Commitment to compliance, ethics, and organizational policies is expected.

Qualifications include a bachelor's degree in healthcare administration, finance, business, or related field preferred or equivalent experience, a minimum of 3-5 years healthcare revenue cycle experience, and demonstrated skills in underpayment or payment variance analysis. Experience with outpatient reimbursement, payer methodologies, contract interpretation, CMS-1500 claim structure, and CPT/HCPCS codes are preferred. Proficiency in Excel for data analysis and strong communication and organizational skills are necessary.

This position does not have supervisory duties. Physical demands include moderate activity such as occasional lifting and prolonged sitting, requiring good manual dexterity and normal vision and hearing.