Revenue and Recovery Analyst at Health Source MSO

Job Description:

A Revenue and Recovery Analyst will be assessing all potential recoverable revenue by examining paid claims. This position will also provide guidance to claim processing operation as well as assist with inquiries from internal and external providers relating to overpayments.

Responsibilities include, but not limited to:

• Maintain knowledge of company policies and procedures including ICD-9/10, CPT, HCPC codes, Medicare and Medi-Cal reimbursement guidelines
• Understand and adhere to AB1455 Regulations
• Maintain knowledge of all aspects of contracts
• Review and analyze generated reports
• Analyze PDRs to ensure correct payment was issued
• Communicate with providers for reason of refund request
• Identify errors and investigate root cause and the possibility of additional recoveries.
• Generate overpayment letters to providers requesting recoupment of incorrect paid claims
• Review and evaluate providers’ reason for refund(s)
• Compile data for forecasting and create trend reports
• Develop action plans for all potential recoveries throughout the department
• Propose possible solutions based on findings
• Guide and advise supporting departments
• Provide monthly reports for management analysis
• Other duties as assigned
  
  

Qualifications:

• Bachelor’s degree in related field or AA degree with related experience
• At least 3 years of managed care experience in the healthcare industry
• At least 2 years of financial analysis experience in healthcare
• Strong critical and analytical skills.
• Must have medical background and medical terminology knowledge
• Must be able to meet deadlines
• Must be able to work in a confidential manner
• Must have good written and communication skills
• Must be able to educate and guide others in an understandably manner
• Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment
• Computer literate including proficiency in Microsoft Word, Excel, Outlook, EZ-CAP, and Crystal Report
• Typing skills of at least 40 wpm