Insurance Recoupment Specialist - Revenue Integrity - FT 1.0 (80 hrs biweekly) (63945)

MEMORIAL HEALTH SYSTEM

16d

About The Position

In an environment of continuous quality improvement, the Insurance Recoupment Specialist is responsible for managing and resolving insurance recoupments, offsets, and take-backs to ensure accurate and compliant revenue recognition within the health system. This role supports the Revenue Integrity Department by identifying, researching, validating, and reconciling payer-initiated recoupments, as well as working collaboratively with internal departments and payers to prevent inappropriate recoveries and maintain compliance with payer contracts and regulatory requirements.

Requirements

• An Associates degree (or equivalent experience) in a healthcare-related field is required.
• Demonstrated leadership skills.
• Excellent verbal, presentation, and written communication skills.
• Advanced critical thinking, problem-solving and analytical abilities.
• Ability to inspire and influence others to accomplish goals.
• Ability to work effectively under strict time constraints.
• Flexibility to manage changing priorities.
• High standards for performance, quality, credibility and integrity.

Nice To Haves

• Bachelor degree (or equivalent working experience) in a healthcare-related field is preferred.

Responsibilities

• Review, analyze, and reconcile insurance recoupments, take-backs, offsets, and overpayment requests from payers.
• Validate the accuracy and legitimacy of payer recoupments in accordance with payer contracts, billing regulations, and internal policies.
• Coordinate with Patient Financial Services, Coding, Compliance, and Contracting teams to research and resolve disputed recoupments or incorrect adjustments.
• Initiate appeals or refund requests when payer recoupments are found to be inaccurate or non-compliant.
• Monitor and track recoupment activity in the billing system to ensure proper financial reporting and timely resolution.
• Participate in Revenue Integrity initiatives to improve charge capture accuracy, compliance, and revenue protection.
• Prepare detailed documentation to support findings, appeals, and audit responses.
• Utilize independent judgment and exercise discretion to ensure timely review and auditing of recouped claims.
• Identify root causes of recoupment trends and collaborate with internal teams to implement corrective actions or process improvements.
• Maintain current knowledge of payer policies, reimbursement methodologies, and federal/state regulations affecting overpayments and recoupments.
• Assist with developing and maintaining reporting metrics related to recoupment volumes, trends, and financial impact.
• Consistently maintain productivity and accuracy standards in highly challenging environment.
• Assumes all other duties and responsibilities as necessary.

Benefits

• Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees.
• To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits.
• Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees