Revenue Integrity & Underpayment Recovery Analyst

Revenue Integrity & Underpayment Recovery Analyst

Hybrid
• Center City 33 S 9th
- Philadelphia, PA 19107

Level Experienced Position Type Full Time Job Shift Day Shift Education Level High School

Job Summary:

The Revenue Integrity & Underpayment Recovery Analyst is responsible for identifying, analyzing, and recovering contractual underpayments from commercial and government payers. This role leverages contract management technology, automation tools, reporting platforms, and advanced analytics to detect payment variances, quantify financial impact, prioritize recovery opportunities, and drive resolution with payers. The Analyst independently 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.

The role also performs root cause analysis to prevent recurring underpayments and serves as a payer policy resource by monitoring reimbursement and coverage policy changes, assessing financial and operational impact, and communicating actionable guidance to Revenue Cycle, Contracting, Coding, Compliance, Finance, Operations, and leadership teams. As the function grows, this position will help document standard work, improve automation effectiveness, and support scalable underpayment recovery workflows.

Key Accountabilities:

• 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.

Essential Duties: