Revenue Integrity & Underpayment Recovery Analyst
$65,000–$80,000 year
HybridPhiladelphia, Pennsylvania, United States
Job Summary
Identify and quantify contractual underpayments, payment variances, and revenue optimization opportunities using remittance data, contract terms, and automation-enabled audit tools. Independently manage underpayment recovery efforts, including claim research, payer file preparation, appeals, and validation that payments have been corrected. Review provider contracts, payer policies, and reimbursement guidelines to interpret coverage determinations and administrative requirements. Develop and optimize audit specifications, recovery workflows, and dashboards to improve yield and process efficiency. Perform root cause analysis of underpayment trends and partner with cross-functional teams to implement corrective actions. Monitor payer policy updates and communicate findings, recommendations, and required workflow changes to management and stakeholders. Maintain organized repositories for contracts, fee schedules, and recovery documentation. Work Monday through Friday from 8:00am to 4:30pm in Philadelphia, PA, with remote eligibility after on-site training.
Required Qualifications
- HS diploma or GED
- Minimum of 3-5 years of experience in healthcare reimbursement, revenue integrity, managed care contracting, payment variance analysis, payer appeals, underpayment recovery, or revenue cycle operations
- Knowledge of healthcare reimbursement, payer contracts, fee schedules, claims adjudication, remittance review, payer appeals, and revenue cycle workflows
- Understanding of commercial and government payer payment methodologies, payer policies, and reimbursement guidelines
- Have a working knowledge of Microsoft Office (Word, Excel, Outlook)
- Proficiency in billing databases (such as EcW, Epic or Cerner), and contract management software
- Must be able to lift 50 lbs
Desired Qualifications
- Certified Professional Coder
- Experience in physician practice, orthopedics, musculoskeletal care, ambulatory surgery
- Experience with contract management, payment variance, or revenue integrity tools
- Knowledge of billing and EMR systems, denial management processes, and physician revenue cycle operations
- Understanding of orthopeadics
- Familiarity with Medicare, Medicaid, workers compensation, and commercial payer reimbursement structures
- Advanced Excel, data visualization, and reporting
- Process improvement, and automation workflow experience
- Ability to support future team growth by documenting standard workflows, training materials, audit methodologies, and operating metrics
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