Recovery Reimbursement Analyst

Halifax Health•Daytona Beach, FL

10d

About The Position

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

Requirements

High school diploma or GED equivalent required.
At least 2 to 5 years of revenue cycle work 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 apply 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 in teams, prioritize and coordinate multiple activities, take initiative, and work effectively in a fast-paced, collaborative environment.

Nice To Haves

Associate of Arts or Associate of Science 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 resolution through appeals or reconsideration.
Ensure reimbursement and follow-up 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 needed for challenged claims.
Track and document underpayment reconsiderations and appeals in the contract management system.
Calculate and enter adjustments into the host system while appeals are pending, and finalize batches at the close of business daily.
Document activities in the contract management system.
Assist with appeals for technical denials as needed.
Address aged accounts promptly to reduce accounts receivable and maximize contract reimbursements.
Monitor system issues affecting contract and underpayment calculation integrity and serve 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.
Gather documentation to support reconciliation or appeals.
Identify and report data and collection trends or barriers to claim resolution.
Meet or exceed defined production goals.
Perform other duties as assigned.