Note: The job is a remote job and is open to candidates in USA. Pathways is an organization providing the Revenue Cycle Operations Analyst role to support California operations. The position analyzes and improves front-end revenue cycle workflows, eligibility verification, financial clearance, authorization management, and billing readiness while identifying risks and process improvement opportunities. The analyst develops reporting and performance metrics, provides operational guidance, supports training and compliance activities, and collaborates with clinical, operational, billing, and leadership teams.
Responsibilities
- Analyze front-end revenue cycle workflows, eligibility verification processes, financial clearance activities, and billing readiness across multiple programs
- Interpret Medi-Cal, Medi-Medi, commercial payer, authorization, Share of Cost, and eligibility requirements and provide operational guidance
- Develop, implement, and maintain revenue cycle procedures, controls, and best practices that support compliant and efficient operations
- Prioritize revenue cycle issues, identify risks, and coordinate corrective actions with operational and revenue cycle leadership
- Review billing errors, financial clearance trends, and workflow exceptions to identify root causes and improvement opportunities
- Recommend and monitor corrective action plans to improve claim readiness and reduce denial risks
- Develop and maintain key performance indicators (KPIs), dashboards, scorecards, and operational reports
- Analyze operational and financial data to identify trends, forecast risks, and support performance improvement initiatives
- Present findings, recommendations, and action plans to leadership and stakeholders
- Design and deliver training related to payer requirements, eligibility processes, financial clearance, and billing readiness standards
- Provide subject matter expertise on EHR and billing platforms, including IRIS, Avatar, or similar systems
- Collaborate with clinical, operational, billing, and leadership teams to improve workflows and support organizational goals
- Participate in county, operational, revenue cycle, and cross-functional meetings as needed
- Support contract compliance, reporting requirements, audits, and operational initiatives
- Perform additional duties as assigned
Skills
- · Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Analytics, Public Health, or a related field, or an equivalent combination of education and directly related experience
- · Minimum three years of revenue cycle, billing operations, financial clearance, healthcare operations, payer operations, or related analytical experience
- · Experience interpreting Medi-Cal, Medi-Medi, commercial payer, eligibility, authorization, Share of Cost, and claim readiness requirements
- · Experience analyzing operational data and developing reports, dashboards, and performance metrics
- · Experience with EHR and billing platforms such as IRIS, Avatar, or similar systems
- · Advanced proficiency in Microsoft Excel and reporting tools
- · Strong analytical, critical thinking, and problem-solving skills
- · Ability to exercise independent judgment and make recommendations regarding complex operational issues
- Travel required up to approximately 30% for meetings, training, program support, and operational initiatives
- · Experience supporting multiple programs, regions, or business units
- · Experience with healthcare KPI reporting, dashboard development, business intelligence, or data visualization tools
- · Knowledge of County behavioral health systems, public behavioral health funding structures, and payer contracts
- · Experience leading process improvement initiatives, workflow redesign, or cross-functional projects
- · CRCR, CHAA, HFMA, Lean Six Sigma, or related certification preferred
Benefits
- Paid vacation days (increase with tenure)
- Separate sick leave that rolls over annually
- Paid holidays
- Medical, dental, and vision insurance options
- DailyPay – access your earnings without waiting for payday
- Training, development, and professional growth opportunities
- 401(k)
- Employee Assistance Program (EAP)
- Pet insurance
- Perks @ Clarvida – national discounts on shopping, travel, Verizon, and entertainment
Company Overview
Company H1B Sponsorship