Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a mission-driven health care solutions organization serving communities through integrated managed care and related services. The Revenue Cycle Analyst Lead oversees end-to-end premium revenue cycle activities from enrollment through payment, including reconciliation, reporting, compliance, and issue resolution. The role also provides operational leadership, develops analytical and automation solutions, supports audits, and mentors analysts.
Responsibilities
- Analyze, Lead and oversee premium revenue reconciliations across 834 enrollment files, 820/835 payment files, member payments, Lock-In files, Jiva, Data Warehouse, Data Lake, Databricks, and Facets systems
- Serve as the primary resource for complex discrepancy research, root-cause analysis, issue resolution, and financial impact assessments
- Strong analytical skills to identify financial trends and anomalies
- Coordinate daily operational activities, assign work priorities, monitor workloads, and ensure completion of critical deliverables and regulatory reporting requirements
- Partner with Vendors and Contractors to develop whatever is needed for member facing materials based upon contractual requirements
- Develop, maintain, and optimize SQL queries, Databricks workflows, databases, dashboards, automation solutions, and reporting tools to improve efficiency and data quality
- Review reconciliation results, audit support documentation, state reports, and management reporting for completeness, accuracy, and compliance
- Lead testing efforts for new system implementations, enhancements, regulatory changes, and process improvements
- Mentor analysts, provide training, facilitate knowledge sharing, and support onboarding of new team members
- Supports management when needed, including leading team meetings, monthly reporting and all other requests
- Identify and implement process improvements, automation opportunities, and control enhancements in partnership with the Automation & Innovation team
- Generate and update monthly reconciliation reports, audit support materials, and other required reporting; review results for material differences and escalate issues to management when appropriate
- Perform other duties as assigned
Skills
- Remote within the United States, working Eastern Standard Time
- For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required
- Bachelor's Degree
- 5 or more years experience
Benefits
- Flexible work solutions including remote options and hybrid work schedules
- Paid time off including holidays and volunteer events
- Health insurance coverage for you and your dependents on Day 1
- 401(k)
- Tuition reimbursement
- Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement
Company Overview
Company H1B Sponsorship