Join the transformative team atCity 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.

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 of maintaining its relations with third-party payors while upholding contracts and confirming reimbursement objectives are achieved.

As a successful candidate, you will:

• Perform due diligence to ensure accuracy in City of Hope’s collections and recovers any funds related to underpayments.
• Perform analyses of payment trends by payor, contract, revenue code, HCPCS, claim type, patient class, etc. to identify underpayments.
• Perform 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.
• Identify and document root causes of overpayments along with remediation recommendations. Work with payors to recover underpayments including follow-up calls and written appeals.
• Perform comprehensive research and analyses of claims data to determine and/or identify billing abnormalities, practices or abusive billing activity. To address the misuse of payment agreements that trigger underpayments, maintain consistent, professional communication with payors, administers follow-up efforts (via email, phone, payor portal websites), and/or issues appeal letters.
• Develop and implement procedures for filing reimbursement claims and ensures timely and accurate claims payment. Serve as resource for staff, and payors seeking to resolve questions and/or concerns related payment variances.
• Research and proactively apply new hospital regulations and legislations. Prepare and submits strong appeals that result in revenue recovery for all types of denials including contract underpayments, billing issues, payor error denials, etc.

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
• Strong analytical, quantitative skills, and data modeling highly preferred

Additional Information:

Job Status: Full time, exempt

Salary range $89,796 - $139,193

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.