Sr Payment Integrity Recovery Analyst - Remote

Join the transformative team at City of Hope , where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, andtreatment facilitiesin Atlanta, Chicago and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

We have an exciting opportunity to join the Patient Business Services department for a Senior Payment Integrity Recovery Analyst position. The successful candidate will be responsible for City of Hope's reimbursement integrity by conducting payment discrepancy analyses, initiating underpayment reclamation, monitoring payment activity, and communicating with payors. This position serves as a key individual contributor towards City of Hope's practice to maintain its relations with third-party payors while upholding contracts and confirming reimbursement objections are achieved.

As a successful candidate, you will:

• Performs due diligence to ensure accuracy in City of Hope's collections and recovers any funds related to underpayments.
• Performs analyses of payment trends by payor, contract, revenue code, HCPCS, claim type, patient class, etc. to identify underpayments. Monitors, evaluates and reviews all cost reporting in support of claims.
• Performs algorithm research, development, and maintenance for the purpose of processing hospital data to identify underpayments. Analyze correspondence to identify strategies that determine future pipeline opportunities. Support team efforts in leading concepts/projects to completion/implementation, and perform necessary research of governmental regulatory agencies for reference as needed.
• Conducts various mathematical calculations to determine the degree of false positive underpayments, and/or verifies the contract accuracy rate to report to the ConnectHope Contract Analyst.
• Identifies and documents root causes of overpayments along with remediation recommendations. Works with payors to recover underpayments including follow-up calls and written appeals.
• Remains current with payor contracts and billing regulations to identify accurate paymeint methodology and misuse, resolve accounts with discrepancies from expected payment to ensure compliance with the contracted terms that pertain to payment methodologies and reimbursement practices.
• Closely examines payor contract language and translate into data modeling to facilitate proper pricing.
• Performs comprehensive research and analyses of claims data to determine and/or identify billing abnormalities, practices or abusive billing activity. To address the misuse of payment agreements that trigger underpayments, maintains consistent, professional communication with payors, administers follow-up efforts (via email, phone, payor portal websites), and/or issues appeal letters.
• Collaborates with various staff (e.g., collectors, Sr. Billing Managers, etc.) to identify common causes of underpayments. Consistently meet work/performance standards that include payment integrity goals, productivity, quality metrics and monthly savings goals.
• Attends meetings within the Business Office to communicate any observed variances that may contribute to under payments, and helps identify process improvements to prevent underpayments in the future. Adapts to the departmental plans and priorities to address business and operational challenges.
• Develops and implements procedures for filing reimbursement claims and ensures timely and accurate claims payment. Serves as resource for staff, and payors seeking to resolve questions and/or concerns related payment variances.
• Through demonstration and leadership, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements
• Research and proactively apply new hospital regulations and legislations. Prepares and submits strong appeals that result in revenue recovery for all types of denials including contract underpayments, billing issues, payor error denials, etc.
• Interact effectively with internal teams to assist data reviews or claim resolution

Your qualifications should include:

• BA/BS - Economics/Finance/Accounting/Business/Healthcare Administration. Experience may substitute for education requirement
• 5 years of experience in Healthcare accounting, finance, preferably with payor contracts

• Strong analytical, quantitative skills, and data modeling highly preferred

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity and inclusion, please click here.