Revenue Recovery Analyst

Mount Nittany Health•Bellefonte, PA

About The Position

The Revenue Recovery Analyst identifies, analyzes, and resolves hospital and physician payment variances to ensure accurate reimbursement and support revenue integrity. The role combines account-level recovery work with population-level analytics to detect underpayment and overpayment trends, validate contract compliance, and help prevent revenue leakage. The Analyst partners with the Manager of Reimbursement, Revenue Integrity, Patient Accounts, and Finance on expected reimbursement accuracy, payer performance monitoring, root-cause remediation, and preparation for Epic expected reimbursement functionality. The role includes reviewing payment variances and pursuing recoveries, analyzing payer and reimbursement trends, supporting expected reimbursement models and payer rate tables, preparing reports, and collaborating across revenue cycle functions. It also supports adherence to payer contracts and regulatory requirements, audit readiness, and awareness of reimbursement and payer policy changes. The position receives primary supervision from the Manager Reimbursement under the leadership of the Director of Revenue Integrity & Reimbursement Strategy and has no supervisory responsibilities.

Requirements

Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field preferred; an equivalent combination of education and relevant experience is considered.
Minimum 3–5 years of healthcare revenue cycle experience preferred.
Demonstrated experience in underpayment or payment variance analysis preferred.
Experience with hospital and/or outpatient reimbursement preferred.
Familiarity with government and commercial payer methodologies preferred.
Strong understanding of hospital and outpatient reimbursement methodologies.
Ability to interpret payer contracts and remittance advice.
Advanced analytical and problem-solving skills.
Proficiency in Excel, including pivot tables, lookups, and data analysis.
Strong attention to detail and organizational skills.
Ability to manage multiple priorities and meet deadlines.
Effective written and verbal communication skills.
Ability to work independently and collaboratively.
No license, certification, or registration required.

Nice To Haves

Experience with revenue cycle systems such as Meditech, Epic, Quadax, or similar.
Knowledge of UB-04 and/or CMS-1500 claim structure.
Knowledge of CPT and HCPCS codes.
Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field.
Healthcare revenue cycle experience, underpayment or payment variance analysis, hospital and/or outpatient reimbursement experience, and familiarity with government and commercial payer methodologies are preferred.

Responsibilities

Identify and resolve underpayments and overpayments across government and commercial payers.
Review accounts in detail by comparing expected and actual reimbursement.
Initiate and manage payer appeals and refund processes in accordance with regulatory requirements.
Track and document recovery activity, outcomes, and aging.
Escalate complex payer issues to the Manager of Reimbursement as appropriate.
Resolve payment discrepancies promptly and compliantly.
Monitor payer reimbursement policies, bulletins, and methodology updates; analyze potential financial impacts and escalate material changes.
Develop and maintain reports monitoring reimbursement performance by payer, service line, CPT/HCPCS, and DRG.
Analyze populations to identify systemic payment issues and emerging trends.
Conduct root-cause analysis and partner with Revenue Integrity, Patient Accounts, and Contracting on corrective actions.
Quantify revenue at risk and recovery opportunities.
Monitor payer compliance with contractual reimbursement terms.
Identify opportunities for process improvement and automation.
Support validation of expected reimbursement models and payer payment logic.
Assist in maintaining payer rate tables and reimbursement assumptions.
Provide data support for payer discussions and dispute resolution.
Assist with Epic expected reimbursement readiness and ongoing optimization.
Prepare recurring and ad hoc reports for reimbursement leadership.
Communicate trends and risks to the Manager of Reimbursement and Director of Revenue Integrity & Reimbursement Strategy.
Collaborate with Revenue Integrity, Patient Access, Coding, and Patient Accounts to resolve upstream and downstream issues.
Support development of dashboards and performance monitoring tools.
Participate in cross-functional initiatives to improve revenue cycle performance.
Ensure adherence to payer contract terms and regulatory requirements, including Medicare, Medicaid, and commercial payer guidelines.
Support audit readiness and documentation standards.
Stay current on reimbursement rule changes and payer policy updates.
Perform related and miscellaneous duties as assigned.