RCM Revenue Recovery Analyst

RCM Revenue Recovery Analyst

Fully Remote 95-00-Corporate - Asheville, NC 28803

Position: Revenue Recovery Analyst

Responsible To: Director of Revenue Cycle Management

Job Summary: The Revenue Recovery Analyst is responsible for identifying, analyzing, and resolving discrepancies in insurance payments to ensure accurate reimbursement and maintain the organization's revenue integrity objectives. This role involves both targeted recovery initiatives for specific accounts and comprehensive analytics at the population level to detect patterns of underpayment and overpayment, ensure compliance with contracts, and facilitate proactive measures to prevent revenue loss.

Responsibilities Include, But Are Not Limited To, The Following:

• Identify and resolve underpayments and overpayments across government and commercial payers.
• Perform detailed account reviews comparing expected vs. 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 RCM leadership as appropriate.
• Ensure timely and compliant resolution of payment discrepancies.
• Monitor payer reimbursement policies, bulletins, and payment methodology updates to identify potential financial impact. Perform preliminary analysis and escalate material changes to reimbursement leadership for further evaluation and action.

Analytics, Trending & Root Cause:

• Develop and maintain reports to monitor reimbursement performance by payer, service line, CPT/HCPCS
• Perform population-level analysis to identify systemic payment issues and emerging trends.
• Conduct root cause analysis and collaborate with Director of Revenue Cycle Management, Managed Care Contracting, and Practice Operations to implement corrective actions.
• Assess revenue at risk and potential recovery opportunities.
• Monitor payer compliance with contractual reimbursement terms.
• Identify opportunities for process improvement and automation.

Other

• Ability to work independently and as part of a team with the capability to shift between projects while maintaining productivity and efficiency.
• Attend Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.
• Maintain patient confidentiality, comply with HIPAA and compliance guidelines established by the practice to protect RCM operations by keeping information confidential.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attend all meetings as requested, including regular staff meetings.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP Ethics Point hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards, and policies.
• All other projects and duties as assigned.

Qualifications

Educational Requirements:

• Bachelor's degree in healthcare administration, finance, business, or related field preferred.
• Equivalent combination of education and relevant experience considered.

Qualifications And Experience:

• Minimum 35 years healthcare revenue cycle experience preferred.
• Demonstrated experience in underpayment or payment variance analysis preferred.
• Experience working with outpatient reimbursement preferred.
• Familiarity with government and commercial payer methodologies preferred.

Knowledge, Skills, Abilities:

• Ability to interpret payer contracts and remittance advice.
• Advanced analytical and problem-solving skills
• Proficiency in Excel (pivot tables, lookups, data analysis)
• Knowledge of CMS-1500 claim structure preferred.
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities and meet deadlines.
• Effective written and verbal communication skills
• Ability to work both independently and collaboratively.
• Knowledge of CPT and HCPCS codes preferred.

Supervisory Responsibilities

This position does not have any supervisory duties.

Typical Physical Demands

Physical demand is moderate with occasional lifting of items weighing 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye - hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.