Revenue Cycle Specialist – Hospital Managed Care Audit & Underpayment Analysis
Healthcare Retroactive Audits, Inc. (HRA) is seeking two experienced Revenue Cycle Specialists to join our hospital managed care recovery team.
This is not a traditional billing, data-entry, or single-account follow-up role. The Revenue Cycle Specialist will investigate hospital claims in bulk, identify underpayment and denial trends, analyze payer reimbursement activity, and support recovery efforts on behalf of hospital clients.
The ideal candidate is analytical, detail-oriented, comfortable working across large account populations, and able to connect patterns across patients, dates of service, payers, contracts, and reimbursement outcomes.
Core Responsibilities
- Review and analyze hospital claims, payment activity, denials, and account history to identify potential underpayments, reimbursement variances, and recovery opportunities.
- Investigate accounts in bulk and identify recurring patterns across multiple patients, dates of service, payers, facilities, and claim types.
- Review client-system notes, remittance information, payer correspondence, authorization history, and other available documentation to determine the root cause of payment discrepancies.
- Analyze managed care reimbursement issues, including contract-rate variances, authorization denials, coding-related payment issues, payer policy conflicts, and billing guideline discrepancies.
- Distinguish between inpatient and outpatient billing scenarios and understand the reimbursement implications of each.
- Review payer policies, billing guidelines, reimbursement methodologies, and managed care contract language to support accurate findings.
- Identify recurring issues and communicate findings to the appropriate internal team.
- Prepare clear, accurate findings and supporting documentation for internal review and next-step action.
- Validate account status, payment information, and supporting documentation before finalizing recommendations
- Maintain accurate and detailed documentation of findings, research, account activity, and recommended next steps.
- Collaborate with analysts, clinical staff, collections personnel, and leadership to improve workflows, identify recurring payer issues, and support revenue recovery initiatives.
- Follow established quality-control standards and ensure all work is accurate, complete, and supported by available documentation.
- Protect confidential patient and client information in accordance with HIPAA and Company policies.
Required Qualifications
- Minimum of 3 years of hospital revenue cycle, hospital billing, managed care, accounts receivable, denial management, audit, or reimbursement experience.
- Experience working with hospital claims, including both inpatient and outpatient accounts.
- Strong understanding of hospital billing workflows, claim adjudication, denials, payment variances, and accounts receivable follow-up.
- Working knowledge of managed care contracts, reimbursement methodologies, payer policies, billing guidelines, and authorization requirements.
- Ability to investigate complex account issues and determine root cause rather than simply follow a checklist.
- Strong analytical and critical-thinking skills, with the ability to identify patterns across multiple accounts.
- Strong attention to detail and commitment to accuracy.
- Advanced Microsoft Excel skills preferred, including pivot tables, filters, formulas, lookups, sorting, and data analysis.
- Ability to work independently, manage multiple priorities, and meet productivity and quality expectations.
- Strong written and verbal communication skills.
- Experience with Epic or other hospital patient accounting, billing, or claims systems is preferred.
Preferred Experience
- Managed care underpayment recovery.
- Contract compliance or reimbursement audit work.
- Hospital denial management.
- Commercial payer, Medicare Advantage, Medicaid Managed Care, or payer-specific reimbursement experience.
- Experience identifying trends across high-volume account populations.
- Experience working with remittance advice, EOBs, payer portals, claim notes, and supporting documentation.
What We Are Looking For
We are looking for someone who:
- Does not take account information at face value.
- Can investigate beyond the initial denial or payment explanation.
- Understands that multiple accounts may reveal a larger payer or reimbursement trend.
- Can identify when an issue requires escalation, appeal, additional documentation, or deeper review.
- Values accuracy and understands the financial impact of incorrect account disposition.
- Is comfortable working in a fast-paced, performance-driven environment.
Additional Information
- This is a full-time remote position.
- Candidates must reside in a state where HRA is currently registered to employ staff.
- Standard business hours are Monday through Friday, 8:00 AM to 5:00 PM Eastern Time.
- All employees must complete HIPAA training and comply with Company security, confidentiality, and data-handling policies.
- Employment is at-will.
Healthcare Retroactive Audits, Inc. is an equal opportunity employer.
Pay: $49,385.72 - $59,475.27 per year
Benefits:
Work Location: Remote
