Description
Job Title : Manager - Claims Revenue Recovery
Department : Ops - Claims Ops
The Revenue & Recovery Claims Manager is responsible for overseeing the daily operations of the claims recovery and revenue integrity team. This role ensures accurate processing of claims, identification of recovery opportunities, compliance with regulatory and contractual recoupment procedures, and effective resolution of discrepancies. The Manager provides leadership, guidance, and performance management for staff while partnering with internal departments and external stakeholders to optimize revenue and minimize financial risk. Work Environment :
- Hybrid work setting, with potential need to attend meetings onsite.
What You'll Do
Lead the claims recovery team in achieving operational goals and recovery targetsMonitor and report on key departmental KPIs, including but not limited to :
Recovery rateAverage claim cycle timeCost savings and efficiency metricsUse KPI data to identify trends, gaps, and opportunities for process improvementSupervise the day-to-day operations of the revenue and recovery claims team, ensuring accuracy, efficiency, and complianceMonitor claims processing and recovery activities to identify trends, issues, and opportunities for improvementEnsure proper review, validation, and resolution of claim discrepancies, denials, overpayments, and underpaymentsCollaborate with payers, providers, and internal teams to address revenue recovery and reconciliation issuesDevelop and implement policies, procedures, and performance standards aligned with organizational goalsGenerate and analyze reports to track performance, recovery outcomes, and key metricsTrain, coach, and mentor team members; provide regular feedback and performance evaluationsSupport audits, compliance reviews, and reporting requirements related to claims recovery, notices, and revenue integrityEscalate unresolved or complex issues to management with recommendations for resolutionFoster a positive, collaborative team culture focused on accountability and continuous improvementOversee incoming calls from provider offices related to overpayment noticesOther duties as assignedQualifications
Education :
Bachelor’s degree in healthcare administration, business, finance, or related field (or equivalent experience)Experience :
5-7 years in healthcare claims, revenue cycle, or recovery operationsAt least 4 years in a supervisory or team lead roleKnowledge / Skills :
Strong understanding of healthcare claims processing, reimbursement methodologies, and regulatory requirementsFamiliarity with payer contracts, denials management, and revenue recovery strategiesProficiency with claims systems, reporting tools, and Microsoft Office Suite (Excel, Word, Outlook)Excellent analytical, organizational, and problem-solving skillsStrong leadership, communication, and interpersonal abilitiesYou're great for this role if :
You thrive on solving problems and turning complex claims issues into clear resolutionsYou enjoy leading and developing people, helping them grow while keeping the team focused on resultsYou’re detail-oriented and analytical, but can also see the “big picture” when it comes to revenue cycle impactYou communicate clearly and confidently—whether you’re collaborating with your team, explaining data, designing letter templates. or addressing payers and providersYou’re adaptable and embrace change as an opportunity to improve processes and outcomesYou take accountability, and display ownership of results and find satisfaction in driving efficiency, accuracy, and recovery successEnvironmental Job Requirements and Working Conditions
Our organization follows a hybrid work structure where expectation is to work both in office and at home on a weekly basis and or with potential need to attend meetings onsite. The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754The total compensation target pay range for this role is : $90,000 - $110,000. The salary range represents our national target range for this role.Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.