Note: The job is a remote job and is open to candidates in USA. Pathways is seeking a Revenue Cycle Operations Analyst to support California operations by analyzing and improving front-end revenue cycle performance across multiple programs. The role provides expertise in eligibility verification, payer requirements, authorization management, financial clearance, billing readiness, process improvement, reporting, compliance, and data-driven operational performance.
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
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