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Revenue and Recovery Analyst

Company: Health Source MSO
Location: Alhambra
Posted on: May 27, 2023

Job Description:

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


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

Keywords: Health Source MSO, Alhambra , Revenue and Recovery Analyst, Professions , Alhambra, California

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