Revenue Integrity & Underpayment Recovery Analyst

Identify, analyze, and recover contractual underpayments from commercial and government payers by leveraging contract management technology, automation tools, reporting platforms, and advanced analytics. This role manages payer payment review initiatives from identification through recovery, including data validation, contract interpretation, payer escalation, appeal or corrected claim activity, follow-up, and confirmation of payment correction. Additionally, perform root cause analysis to prevent recurring underpayments and serve as a payer policy resource.

Responsibilities

• Identify and quantify contractual underpayments, payment variances, and revenue optimization opportunities using remittance data, contract terms, fee schedules, payer policies, and automation-enabled audit tools.
• Independently manage underpayment recovery efforts, including claim/payment research, payer file preparation, appeals, corrected claims, payer follow-up, recovery tracking, and validation that payments have been corrected.
• Review and interpret provider contracts, government regulations, commercial payer policies, reimbursement guidelines, medical coverage determinations, and payer-specific administrative requirements.
• Develop, standardize, and optimize audit specifications, recovery workflows, dashboards, and documentation to improve recovery yield, process efficiency, and future scalability of the team.
• Work independently and with data/analytics resources to build pricing models, payer mapping logic, reporting, variance analysis, and prioritization tools.
• Conduct root cause analysis of underpayment trends and partner with Revenue Cycle, Contracting, Coding, Compliance, Finance, Operations, and payer relations teams to implement corrective actions.
• Monitor payer policy updates and assess potential reimbursement, denial, coding, workflow, compliance, and financial impacts.
• Communicate findings, recommendations, recovery status, payer trends, and required workflow changes clearly to management and cross-functional stakeholders.
• Maintain organized repositories for contracts, fee schedules, payer policies, appeal documentation, recovery files, payer correspondence, and internal reference materials.
• Support future team growth by documenting standard operating procedures, training materials, audit methodologies, and performance metrics.
• Manage the process of building contractual terms into software, including adding/updating fee schedules, providers, new contracts, changes in payer policies, rate changes, and carve-out business within contract management software.
• Use remittance data, contract management software, automation outputs, and analytics tools to identify underpayment trends by payer, plan, code, provider, location, modifier, policy, and service line.
• Validate underpayment opportunities, quantify financial impact, determine appropriate recovery path, and prioritize recovery efforts based on dollars, recurrence, payer risk, and operational feasibility.
• Prepare payer-specific underpayment files, appeal packages, corrected claim requests, contract support, and other documentation needed to pursue reprocessing or settlement with payers.
• Communicate directly with payers and internal payer relations resources to resolve payment issues, track outstanding recoveries, escalate unresolved items, and confirm final payment disposition.
• Perform root cause and trend analysis, and work with cross-functional teams to ensure recurring root causes are corrected and future claims are monitored for accurate payment.
• Develop and maintain contract modeling, pricing logic, payer mapping, variance reporting, dashboards, and ad hoc analyses in partnership with contracting, Business Office, and data/analytics teams.
• Evaluate the effectiveness of automated audit routines and recommend enhancements to improve detection accuracy, recovery yield, workflow efficiency, and scalability.
• Research reimbursement trends, payer behavior, policy changes, fee schedule updates, and contract interpretation issues; provide recommendations to optimize revenue capture and reduce payment leakage.
• Maintain centralized repositories for payer policies, reimbursement guidelines, recovery files, payer correspondence, audit documentation, internal reference materials, and standard operating procedures.
• Develop and distribute clear communications summarizing payer policy updates, recovery findings, implementation timelines, required workflow changes, and leadership-level results.

Requirements

• High School diploma or GED.
• Minimum of 3-5 years of experience in healthcare reimbursement, revenue integrity, managed care contracting, payment variance analysis, payer appeals, underpayment recovery, or revenue cycle operations.
• Knowledge of healthcare reimbursement, payer contracts, fee schedules, claims adjudication, remittance review, payer appeals, and revenue cycle workflows.
• Understanding of commercial and government payer payment methodologies, payer policies, and reimbursement guidelines.
• Working knowledge of Microsoft Office (Word, Excel, Outlook).
• Proficiency in billing databases (such as EcW, Epic, or Cerner) and contract management software.

Qualifications

• Certified Professional Coder (preferred).
• Experience in physician practice, orthopedics, musculoskeletal care, ambulatory surgery (preferred).
• Experience with contract management, payment variance, or revenue integrity tools (preferred).
• Knowledge of billing and EMR systems, denial management processes, and physician revenue cycle operations (preferred).
• Understanding of orthopedics (preferred).
• Familiarity with Medicare, Medicaid, workers compensation, and commercial payer reimbursement structures (preferred).
• Advanced Excel, data visualization, and reporting skills (preferred).
• Process improvement and automation workflow experience (preferred).
• Ability to support future team growth by documenting standard workflows, training materials, audit methodologies, and operating metrics (preferred).

Schedule

Monday - Friday: 8:00am - 4:30pm

Pay

Suggested salary will be based on candidate's years of direct experience and certification status: $65,000.00 - $80,000.00

Benefits

• Comprehensive health and dental benefits.
• Tuition reimbursement.
• Paid time off.
• Retirement savings plans.

Location

Fully remote, but candidates must reside in DE, FL, GA, MD, NC, NJ, PA, SC, or TX. Option to work on-site if desired: 833 Chestnut St, Philadelphia, PA 19107