POSITION SUMMARY

The Revenue Recovery Specialist is responsible for identifying and resolving underpayments and reimbursement variances through detailed account-level review and payer follow-up. This role ensures reimbursement aligns with contractual terms and expected payment methodologies, with a focus on maximizing net revenue recovery.

This position performs work primarily within Epic, utilizing variance payment work queues and reporting tools to identify accounts with potential underpayments. The Specialist validates payments, initiates recovery efforts, and resolves discrepancies through structured workflows.

While this role does not own denial management, it plays a key role in identifying trends and collaborating with Patient Accounts to address recurring issues.

This position is execution-focused and partners closely with the Revenue Recovery Analyst and Reimbursement team by escalating patterns, payer behaviors, and system issues identified through daily account work.

MINIMUM REQUIREMENTS

Education:

• Associate’s Degree required
• Bachelor’s preferred

Experience:

• 2 years experience in Revenue Cycle operations preferred, Healthcare industry, or similar background preferred
• Experience working in an EHR or billing system, Epic strongly preferred

Knowledge, Skills, Abilities:

• Strong understanding of claim payment workflows and payer behavior preferred
• Strong attention to detail and persistence in follow-up
• Experience working Epic work queues or similar system-driven workflows
• Experience identifying and resolving underpayments
• Familiarity with payer reimbursement methodologies or contract terms
• Experience working with payer portals and payment review processes
• Basic Excel skills for tracking and documentation

License/Certification/Registration:

None required

SUPERVISION RECEIVED

Receives general supervision from the Manager, Reimbursement.

SUPERVISION GIVEN

None

ESSENTIAL FUNCTIONS

Epic Work queues & Account Review

• Monitors and works Epic variance payment work queues to identify underpayments and reimbursement discrepancies
• Utilizes Epic reports and tools to prioritize accounts based on dollar value, payer, and recovery opportunity
• Reviews claim-level detail within Epic to validate expected vs. actual reimbursement
• Underpayment Identification & Reimbursement Validation
• Validates expected reimbursement against actual payment using contract terms, fee schedules, and internal tools

Identifies payment variances including:

• Incorrect rate application
• Partial or missing payments
• Bundling discrepancies
• Modifier-related payment issues
• Ensures alignment with payer contracts and reimbursement methodologies

Recovery Execution & Payer Follow-Up

• Initiates and manages recovery efforts for underpaid claims through payer follow-up (payer portals, phone, written communication)
• Submits reconsiderations or payment disputes as appropriate to resolve underpayments
• Tracks recovery status and performs timely follow-up to maximize reimbursement

Trend Identification & Escalation

• Identifies recurring issues across Epic work queues and account activity (payer-specific, CPT/DRG-specific, or department-specific)
• Escalates trends and supporting examples to Revenue Recovery Analyst and leadership
• Contributes to root cause identification and broader reimbursement improvement efforts

Collaboration with Patient Accounts

• Partners with Patient Accounts to communicate trends or issues impacting reimbursement identified through Epic work queues
• Provides detailed account examples to support investigation and resolution
• Supports coordinated efforts to address upstream and downstream revenue cycle issues

Documentation & Tracking

• Maintains detailed documentation of:
• Accounts reviewed
• Recovery actions taken
• Dollars recovered
• Ensures accurate Epic account notes and tracking logs for reporting and audit purposes
• Cross-Functional Collaboration

NON-ESSENTIAL FUNCTIONS

Performs related and miscellaneous duties as assigned.