JOB SUMMARY:
We are seeking a Revenue Cycle Analyst who combines strong analytical skills
with a passion for improving operational performance. In this role, you will
analyze payer data, resolve claim denials, and transform insights into
actionable strategies that drive revenue growth.
The Revenue Cycle Analyst is charged with coordinating the analysis and
effective resolution of denied claims with the purpose of reducing overall
denials and increasing revenue. This includes interpreting payment and denial
data down to the line-item detail, identifying payer and coding trends, risks,
and opportunities, to implement operational or systematic improvements.
You will have autonomy and ownership of your assigned payer portfolio in a
full-time, remote capacity.
JOB RESPONSIBILITIES
Analyze revenue cycle data across internal systems and payer portals to
identify trends, patterns, and performance gaps to ensure timely and accurate
reimbursement.
Monitor claims, cash collections, denials, reimbursements, and payer behavior
through daily and weekly reporting.
Track KPIs such as days in A/R, denial rates, net collections, reimbursement
timelines, credit balances, and payor policies such as NCD, LCD and other
coverage policies impacting revenue.
Responsible for prioritizing and managing to resolution denied claims with
third party payors. Research, develop and maintain a solid understanding of
payer requirements, including filing limit, claim processing logic,
coordination of benefits requirements, patient responsibility, and
authorization requirements. Identify appeal opportunities, providing
compelling appeal language for third party payers.
Conduct root-cause analysis for denials, rejections, underpayments, and
delayed payments, recommending actionable solutions. Maintains action plans
for improvements.
Partner closely with internal stakeholders to improve clean-claim rates,
streamline workflows, and enhance overall efficiency.
Create SOP’s, process flows and documentation to enhance denial processing
efficiency.
Partner with Managed Care on payer negotiations and behavior.
Support ad hoc data requests and cross-functional initiatives for revenue
cycle leadership.
Compiles, maintains, and distributes reports to management on success of
appeals and root cause analysis. Serves as subject matter expert of payer
requirements.
Qualifications
EDUCATION & LICENSURE:
Bachelor’s degree in Healthcare Administration, Business, Analytics, or
equivalent experience.
REQUIREMENTS:
Bachelor's degree in related field, or equivalent work experience.
4+ years of experience in healthcare revenue cycle analytics, financial
analysis, or operational data analysis.
Direct experience with claims analytics, denial management, and payer
performance reporting.
Knowledge of insurance billing, Medicare claims, audit processes, compliance
standards, and HIPAA regulations.
Experience with laboratory billing preferred.
Advanced skills with Microsoft applications which may include Outlook, Word,
Excel/Smartsheet’s, PowerPoint and other web-based applications.
Create SOP’s and process flow mappings using Visio.
Familiarity with Xifin billing system a plus.
ABILITIES:
Problem Solving: Ability to address problems that are highly varied, complex,
and often non-recurring, requiring staff input, innovative, creative, and
Lean diagnostic techniques to resolve issues.
Strong analytical skills with the ability to translate data into insights and
operational recommendations.
Solid understanding of healthcare RCM processes (insurance verification,
coding, billing, payment posting, A/R follow-up).
Clear, concise communication skills—comfortable explaining complex findings
to non-technical stakeholders.
Highly organized, adaptable, and comfortable working in a dynamic,
fast-growing environment.
Applies working knowledge in the application of concepts, principles, and
technical capabilities to perform varied tasks.
Basic understanding of EHR systems and functionality.
Comfortable performing analysis and adept at data retrieval via analysis
tools.