Recovery Reimbursement Analyst

Halifax Health•Daytona Beach, FL

22h

About The Position

The Recovery Reimbursement Analyst serves as an operational subject matter expert to help ensure Halifax Health receives appropriate payment for services delivered. Working both independently and as part of a team, the analyst resolves payment variances involving managed care, government contracts, and other payers in a timely and compliant manner. The role focuses on reimbursement analysis, payment resolution, follow-up on assigned accounts, appropriate account adjustments, and thorough documentation in applicable hospital systems. The analyst works with internal groups and contracted payers to investigate underpayment root causes and develop collection techniques. The position requires an understanding of Patient Financial Services functions, including patient access requirements, claims processing, collections, remittance posting, and hospital contract specifics. The analyst identifies and resolves systemic issues that affect revenue capture and reviews, follows up on, and resolves third-party payer underpayments and denials using collection techniques and appeals.

Requirements

High school diploma or GED equivalent.
At least 2 to 5 years of revenue cycle experience in billing, reimbursement, or collections, including experience with Medicare, Medicaid, and managed care reimbursement methodologies.
In-depth knowledge of insurance and government programs, regulations, and billing processes, including Medicare, Medicaid, and managed care contracts.
Ability to interpret contract language and payment methodology factors, including DRG, APC, ASC, fee schedules, per diems, carve-outs, stop-loss provisions, cost thresholds, outliers, bundling, percent of charges, implantables, and case rates.
Ability to perform accurate calculations and demonstrate analytical reasoning.
Strong mathematical skills.
Basic computer skills and essential knowledge of Excel worksheets.
Strong written and verbal communication, organization, accuracy, attention to detail, and time-management skills.
Ability to work independently and on teams, prioritize and coordinate multiple activities, take initiative, work effectively in a fast-paced environment, and collaborate.

Nice To Haves

AS/AA degree in Accounting or Business Administration.
Experience with contract management systems.

Responsibilities

Evaluate variances on paid claims.
Perform contract analysis to validate the accuracy of programmed contract rules.
Identify collectible underpaid amounts and pursue them through appeals or reconsiderations.
Ensure reimbursement and follow-up activities are accurate, timely, and compliant.
Initiate timely appeals and reconsiderations with payers by telephone, letter, email, electronic media, or spreadsheets.
Follow up with regulatory agencies as required for challenged claims.
Track and document underpayment reconsiderations and appeals in the contract management system.
Calculate and enter adjustments accurately into the host system while appeals are pending, and ensure batches are finalized at the close of business daily.
Document all activities in the contract management system.
Assist with appeals for technical denials as needed.
Address aged accounts in a timely manner to reduce accounts receivable and maximize contract reimbursements.
Monitor system issues and help maintain contract and underpayment calculation integrity, serving as a liaison between Managed Care Recovery and PFS IT.
Participate in team development projects and offer solutions to identified payer issues.
Mentor new team members as directed.
Assist other departments with claim analysis as needed.
Assemble documentation to support reconciliation or appeals.
Identify and report data and collection trends or barriers to claim resolution.
Meet or exceed production goals as defined.
Perform other duties as assigned.