Revenue Recovery Analyst, PIH Health Physicians, Salaried

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

The Revenue Recovery Analyst reports directly to the Administrative Director, Managed Care. The Revenue Recovery Analyst is responsible for providing support to the organization in recovering monies owed to the organization. The Revenue Recovery Analyst conducts root cause analyses of underpayments from health plans or overpayments by the Claims Department, and works with the various departments to implement processes for prevention.

Able to effectively negotiate with health plans and providers. Advanced MS Suite user. Ability to analyze data and summarize finding. Effective presentation skills. Thorough understanding of reimbursement methodologies as they relate to managed care contracting. Able to put together training materials for staff.

Required:

• Previous experience in revenue recovery in a hospital, MSO, or medical group environment.
• Knowledge of compliance issues as they relate to health plans, payments, and claims processing.
• Ability to successfully communicate with payors including, but not limited to, health plans, medical groups, capitated payors.

• Strong follow-up skills and time management
• Knowledge of health care reimbursement.
• Knowledge of health plan contracts, professional contracts, and capitation contracts to effectively negotiate with health plans/providers to recover overpayments.
• General knowledge of regulations/laws of regulatory agencies (i.e. CMS, DMHC, DHCS, etc.)
• Exceptional organization skills to organize documents for staff.
• Effective trainer.

Preferred:

• Bachelor's degree in one of the following areas: Business Administration, Accounting, Finance or Healthcare Management OR equivalent education/experience in the managed care/healthcare field.
• Basic understanding of medical care and medical terminology
• Knowledge of payor guidelines, industry billing and coding standards, and denials reason codes
• Data analyst experiences

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V