Recovery Reimbursement Analyst

Staff_02 Halifax Staffing Inc.; Daytona Beach (FL); On-site; USD 52,000 - 76,000; Full time

Job summary

Halifax Health is seeking a Recovery Reimbursement Analyst I to manage and resolve outstanding insurance claims, including denials and unadjudicated balances, with appeals for technical hospital claims. Requires healthcare experience and familiarity with third-party billing processes, plus knowledge of CPT/HCPCS and ICD-10 coding.

Associate/bachelor’s degree or relevant certification preferred; strong PC skills and experience with hospital billing are expected.

Qualifications

• Associate or bachelor’s degree or relevant certification preferred.
• Minimum of three years experience in healthcare with two years of hospital billing claim experience.
• Familiarity with third-party billing and collection process.

Responsibilities

• Review denied claims to determine reason for denial and follow-up actions.
• Work unpaid or underpaid accounts; submit reconsiderations and follow-up for proper reimbursement.
• Submit technical appeals to insurance payers with required documentation.
• Follow-up on appeals to ensure timely resolution and minimize financial impact.
• Investigate payment discrepancies from submission to 835 remittance.
• Collaborate with billing and managed care teams for appeals and dispute resolution.
• Maintain knowledge of CPT/HCPCS and ICD-10 coding per payer guidelines.

Job description

Day (United States of America) Recovery Reimbursement Analyst The Recovery Reimbursement Analyst I is responsible for managing and resolving outstanding insurance claims, including denials, unadjudicated balances with no payer response and claims requiring technical appeal submissions for technical hospital claims. This role requires an understanding of payer policies, medical billing codes and hospital reimbursement protocols. This analyst will work directly with insurance companies and internal departments to ensure timely and accurate reimbursement and resolve any discrepancies in the hospital’s accounts receivable balances. Associate or bachelor’s degree or relevant certification from accredited institution preferred. Requires a minimum of three years previous experience in healthcare (or one year healthcare experience with an associate or bachelor’s degree) with two years of claim experience in hospital billing with complete familiarity of the third-party billing and collection process. Must have general PC operational knowledge and skills. Experience in Epic Resolute Hospital Billing or equivalent experience preferred.

JOB RESPONSIBILITIES AND STANDARDS

• Review and analyze denied claims to determine the reason for denial and identify any necessary follow-up action
• Work accounts that are not paid at the primary expected reimbursement based on hospital agreement with payer or entity; submit reconsiderations and follow-up to receive appropriate reimbursement
• Submit technical appeals to insurance payers, ensuring all necessary documentation is included and adheres to payer requirements
• Follow-up on submitted appeals to track status, ensure timely resolution and minimize adverse financial impact
• Investigate payment discrepancies from claim submission to 835 remittance of payment if denial adjudication does not reconcile to original submission
• Work closely with billing and managed care teams to gather relevant documentation and information required for appeals and dispute resolution
• Collaborate with internal teams to identify root causes and suggest solutions for continuous improvement
• Maintains current knowledge of CPT / HCPCS and ICD-10 coding in accordance with insurance payer guidelines for UB04 claim forms.
• Provide accurate reporting at account level work and re-work to support managed care initiatives and track payer behaviors
• Maintains knowledge of insurance payer contracts in accordance with insurance payer guidelines
• Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with co-workers and customers.
• Other duties as assigned.

OTHER REQUIREMENTS & SPECIFICATIONS

Completion of the assigned training modules Internal Candidates must be without infractions for twelve months Understands the LCDs and Rules and Regulations of CMS Basic Excel knowledge Basic analytical skills Ability to solve problems Completion of the assigned training modules Internal Candidates must be without infractions for twelve months Understands the LCDs and Rules and Regulations of CMS Basic Excel knowledge Basic analytical skills Ability to solve problems

WORK CONDITIONS

The individual spends almost 100% of their time in an air-conditioned building with minimal exposure to excessive humidity and noise. We're glad you're here. As a cornerstone of our community, we need strong, compassionate and talented medical professionals just like you. Our team works together to ensure that families receive the highest-quality care in a pleasant setting where they feel valued. Fraudulent website operators have been trying to direct applicant communication to WhatsApp or other encrypted messaging platforms (Telegram, Signal, etc.) - Halifax Health will only communicate by phone and from halifax.org email addresses.

Recognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women’s health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks.