Revenue Recovery Specialist - 26-122

PriMed Management Consulting Services; San Ramon (CA); On-site; USD 70,000 - 76,000; Full time

Job summary

Hill Physicians Medical Group is seeking an experienced Epic Resolute Professional Billing specialist to manage health plan revenue recovery, from claim review to payment posting and reconciliation.

The ideal candidate has 1–3 years’ hands-on Epic Resolute Billing, claims research, 835/EOB discrepancies, and strong Excel/Word skills to support denial management and accurate reporting in a complex managed-care environment.

Qualifications

• Epic Resolute Professional Billing experience required.
• Experience researching 835 and EOB payment discrepancies.
• Strong knowledge of CPT/HCPCS and ICD-10 coding and payer requirements.
• Proficiency with Excel, Word, and reporting tools.

Responsibilities

• Work daily Pay & Chase work queues handling charge and claim review, denial management, and escalation to recover claims.
• Post and reconcile Health Plan payments and refunds; resolve remittance errors.
• Prepare disputes, appeals, and supporting documentation for denied balances.
• Perform manual claim extraction and payment-only workflows; escalate when needed.
• Monitor outstanding claims and recovery outcomes using Epic reporting and work queues.
• Collaborate with Revenue Cycle, Epic/IT, Accounting, Contracting, Enrollment, and Health Plans to resolve root causes.
• Maintain HIPAA and other regulatory documentation.

Skills

Epic Resolute

Revenue cycle

Analysis

Communication skills

Education

College degree or equivalent

Tools

Excel

Word

Reporting tools

Job description

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&CI Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

IDEAL CANDIDATE PROFILE

An experienced Epic Resolute Professional Billing user with hands-on expertise in claim and charge research, work queues, payment posting, remittance processing, work queues, and A/R reconciliation within a complex managed-care environment.

POSITION SUMMARY

Manages Health Plan revenue recovery activity in Epic Resolute Professional Billing, from claim and charge review through payment posting, reconciliation, and follow-up on outstanding or denied recovery claims. Partners with internal teams and Health Plans to resolve claim, payment, eligibility, and contractual discrepancies across Epic Resolute and Tapestry.

Core Responsibilities:

• Work daily Pay & Chase work queues, including charge and claim review, and denial management, and determine the appropriate correction, follow‑up, or escalation to recover claims.
• Post and reconcile Health Plan payments and refunds, and resolve remittance errors such as unmatched payments, missing charges, unapplied funds, and external payment.
• Prepare disputes, appeals, rebuttals, and supporting documentation for denied or outstanding balances.
• Perform manual claim extraction and payment-only workflows and recognize when manual intervention, system correction, or technical escalation is needed.
• Monitor outstanding claims, workflow errors, and recovery outcomes using Epic reporting and work queue tools.
• Identify recurring workflow, build, or data issues and partner with Revenue Cycle, Epic/IT, Accounting, Contracting, Enrollment, and Health Plans to resolve root causes.
• Maintain accurate documentation per HIPAA, contractual, regulatory, and Health Plan submission requirements.
• Audit Retro Terms (eligibility guarantee) monthly against enrollment and capitation data, partner with Enrollment to correct eligibility and create Resolute recovery requests for payments made to providers in error.

Required Experience and Qualifications:

• Minimum of 1-3 years of hands-on Epic Resolute Professional Billing experience, preferably in payment posting, remittance processing, work queues, or A/R reconciliation.
• Managed-care claims, billing, accounts receivable, or revenue-recovery experience.
• Experience researching 835 and EOB payment discrepancies.
• Working knowledge of medical claims, CPT/HCPCS and ICD-10 coding, benefit structures, and payer requirements.
• Strong analytical and problem-solving skills, with the ability to independently research complex claim and payment discrepancies.
• Proficiency with Microsoft Excel, Microsoft Word, and operational reporting tools.
• Strong organization, attention to detail, and communication skills; ability to manage competing priorities in a productivity-focused environment.
• Knowledge of PHI and HIPAA requirements.

Preferred Qualifications:

• Epic experience spanning Resolute Professional Billing and Tapestry AP Claims workflows.
• Experience with Pay & Chase, delegated billing, payer recovery, insured services, drug reimbursement, eligibility guarantees, or similar revenue-recovery programs.
• Knowledge of Health Plan DOFRs, Coordination of Benefits, authorizations, managed-care contracting, and Medicare, Medi-Cal, CMS, or DMHC requirements.
• Experience using reporting and reconciliation tools to monitor outstanding balances, denials, unapplied funds, and recovery performance.

Education:

College degree or equivalent relevant experience required.

Additional Information

Salary: $70,000 - $76,000 Annual

Hill Physicians is an Equal Opportunity Emp l oyer