Revenue Recovery Specialist (Full-time, Days, Hybrid role)
We are seeking a Revenue Recovery Specialist to identify, collect and determine root causes of underpaid claims by auditing payor performance and analyzing actual payments of payors to ensure contract compliance which is operationally critical and sensitive in nature. This includes utilizing independent judgment to compare actual reimbursement to expected reimbursement, reviewing managed care contract terms, claims billing and clinical information to effectively reconcile underpaid accounts and maintain documentation to support this activity. This requires expert knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills and collaborative skills to uncover and recover payment discrepancy in a complex system and complex payer environment.
In this position you will:
Utilize independent judgment and exercise discretion to ensure timely review and auditing of underpaid claims.
Analyze, collect underpayments and resolve claims with discrepancies from expected payment to ensure payors are in payment compliance with their contracted terms.
Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payer specific processes.
Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third party payers. Work directly with payor to recover payments.
Consistently maintain productivity and accuracy standards in highly challenging environment.
Identify patterns, trends, and root-causes in collection issues and payor performance. Provide information on global payor issues and assist in preparing utilization data to work with payors on collecting additional funds in most efficient manner possible (spreadsheet, project, mass rebill, etc..).
Required qualifications for this position include:
High School Diploma.
Four years of experience in some aspect of Revenue Cycle or Health care finance.
Knowledge of health care payment mythologies, mathematical skills of hospital AR cycle including admitting, coding, billing, collections and posting.
Proficient in Excel and have basic knowledge of how a contract calculation engine works.
Preferred qualifications for this position include:
Associate degree or an equivalent combination of education and / or experience.
Two years of experience with managed care contracts.
Hospital Billing Experience
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Billing/Insurance
Other Location(s): California, California-Torrance
Req ID: 355468