Sr Payment Integrity Recovery Analyst

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, and treatment facilities in 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.

Position Summary:

The Senior Payment Integrity Recovery Analyst is 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 achieve

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 payment 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.
  
  

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

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

To learn more about our Comprehensive Benefits, please CLICK HERE.