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Revenue Recovery Analyst - Decision Support - PHP, Full-Time

Company: PIH Health
Location: Whittier
Posted on: January 11, 2022

Job Description:

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 Whittier Hospital, PIH Health Downey Hospital 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 or follow us on , , or . -The Revenue Recovery Analyst identifies, collects and determines root causes of underpaid. Maintaining strong internal controls over billing processes and root cause analysis relating to all recovery efforts. This position is responsible for reviewing large amounts of remittance data and analyze utilizing databases and modeling tools to identify areas of payment variance to contract or revenue optimization opportunities and take steps (appeals, corrected claims, etc) to solve and capture the contractual underpayments.
Required SkillsNegotiation, personal computer (spreadsheet, database, word processor), contracts analysis, claims adjudication process, and effective communication and presentation skills. Thorough understanding of reimbursement methodologies as they relate to managed care contracting is also required. Basic understanding of medical care and medical terminology preferred.
Required ExperienceRequired: -

  • 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.
    • Previous experience in HMO or IPA environment.
    • Knowledge of compliance issues as they relate to claims processing.
    • Ability to successfully communicate with payors including insurance companies, health plans, and medical groups.
      • Strong follow-up skills and time management; Knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills and collaborative skills to uncover and recover payment discrepancy. -Preferred: -
        • Basic understanding of medical care and medical terminology preferred
        • Knowledge of payor guidelines, industry billing and coding standards and denials reason codes
        • Data analyst experiences
        • MS SQL/MS Access 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

Keywords: PIH Health, Whittier , Revenue Recovery Analyst - Decision Support - PHP, Full-Time, IT / Software / Systems , Whittier, California

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