The Recovery Analyst is responsible for analyzing payor contracts for assigned payors and utilizing a proprietary free-standing contract management software and related technologies for identifying potential underpayments. Independently interprets third-party payor contracts, government or commercial contracts, and evaluates contract terms to identify underpaid claims to be pursued. Responsible for preparing and submitting documentation in support of each appeal/reconsideration request to payors when such underpaid claims are identified. Recovery Analysts must develop a working knowledge of each payor’s reimbursement policies, rules, and appeal processes. Serves as contract subject matter experts for the D-H Contracting team and the organization.

1. Identifies payment issues associated with payor contracts.
2. Evaluates accuracy of contract calculations for claims and payment data loaded into the contract management system.
3. Presents a professional argument to payors so that underpaid claims are corrected following appropriate research and identification.
4. Prepares and submits appeal/reconsideration supporting documentation to address payor concerns when warranted.
5. Follows-up with payors on a consistent basis to ensure each identified claim is resolved in a timely fashion.
6. Establishes and maintains effective communications with payors, D-H Contracting team, Conifer/D-H billing operations and other stakeholders as applicable.
7. Achieves established production goals and provide monthly updates on progress towards these goals to the D-H Contracting leadership team.
8. Identifies and communicates documented process improvement areas to D-H Contracting and Conifer/D-H billing operations, including billing inefficiencies or systemic issues requiring programming modifications.
9. Performs other duties as required or assigned.

• Bachelor’s degree with an emphasis on finance, healthcare reimbursement, third-payor payor contracting, and/or closely related field with 5 years of experience, or the equivalent in education and experience required.



• Solid skills in Microsoft applications: spreadsheets, word processing, data base applications and knowledge of billing system applications desired.



• Strong data and analytical skills and abilities are required.



• Familiarity with free-standing contract management systems or EPIC Clinical and Business systems desired.



• Proficiency with facility and professional governmental and commercial payor contract reimbursement methodologies



• Strong organization and project management skills are essential.



• Ability to present and communicate arguments in a professional manner to payors



• Additional relevant experience in a hospital setting of comparable size and large group practice experience preferred.



• Must also be comfortable working with various payors and co-workers at all levels of the applicable organization.



• Proven ability to manage multiple projects and competing deadlines while working independently with little supervision desired.



• Must possess the ability to be organized in a fast-paced matrix environment and be able to act in a consulting capacity.

• None