Restructuring and Turnaround Services, Healthcare and Life Sciences - Senior Associate (Revenue[...]

Restructuring and Turnaround Services, Healthcare and Life Sciences - Senior Associate (Revenue Cycle Management) As an Analyst in our Healthcare and Life Sciences practice, you will serve as a subject matter resource on revenue cycle management, reimbursement analytics, denial management, and payer contract performance across a diverse client portfolio spanning healthcare providers and payers. You will leverage deep functional expertise to analyze complex financial and operational data, surface underpayment and denial trends, evaluate payer contract compliance, and deliver actionable recommendations that drive measurable improvements in net revenue and cash performance. This is a high-impact role for a seasoned‑analytics professional ready to apply provider‑ and payer‑side experience in a fast‑paced advisory consulting environment. Who You Are: You hold a Bachelor’s degree in Finance, Accounting, Health Administration, Health Information Management, or a related field; a Master’s degree is a plus. You have a minimum of 3 years of hands‑on experience in provider and/or payer analytics, with a strong track record in reimbursement analysis, denial management, underpayment identification, and payer contract evaluation. You possess extensive knowledge of commercial, Medicare, and Medicaid reimbursement methodologies, fee schedules, and payment structures, including DRG, APC, RBRVS, and value‑based payment models. You have deep expertise in denial management — including denial categorization, root cause analysis, trending, and appeals — with the ability to design denial prevention strategies and quantify financial impact. You have demonstrated experience identifying and recovering underpayments through systematic contract modeling, remittance auditing, and payer comparison analysis. You are proficient in payer contract analysis, including rate modeling, reimbursement adequacy assessment, and identification of contractual versus non‑contractual variances. You are highly proficient in Microsoft Excel for complex financial modeling, and experienced with data analytics tools such as Power BI, Tableau, SQL, or comparable platforms used in RCM analytics environments. You have working knowledge of at least one major EHR or practice management system (e.g., EPIC, Cerner, Athenahealth) and clearinghouse/claims data environments. You are familiar with CPT, ICD‑10, HCPCS, and revenue code conventions as they relate to billing accuracy and reimbursement outcomes. You communicate complex findings clearly and confidently, both in written deliverables and in verbal presentations to client stakeholders. Experience working across both provider and payer environments, with the ability to interpret claims data and adjudication logic from multiple perspectives. Familiarity with value‑based care reimbursement models, shared savings arrangements, or risk‑based contracting structures. Experience with RCM technology platforms, clearinghouses, or denial management software (e.g., Waystar, Change Healthcare, Optum360). Knowledge of HIPAA compliance, healthcare data privacy standards, and audit response protocols. Prior experience in a consulting, advisory, or professional services environment. What You’ll Do: Lead analytical workstreams across RCM engagements, with a primary focus on reimbursement performance, denial management, underpayment recovery, and payer contract compliance. Conduct comprehensive denial analyses — including segmentation by denial reason, payer, service line, and provider — to identify systemic root causes and quantify revenue at risk. Perform underpayment audits by modeling expected reimbursement against payer contract terms and adjudicated payments, flagging variances, and supporting recovery efforts. Analyze payer contracts to assess reimbursement adequacy, identify rate discrepancies, and support contract negotiation or renegotiation initiatives. Build and maintain dynamic reimbursement models, denial trending dashboards, and KPI scorecards that track performance against benchmarks and improvement targets. Evaluate remittance data, EOBs, and payer adjudication patterns to detect underpayment trends, systematic errors, and payer behavior anomalies. Research Medicare and Medicaid reimbursement updates, CMS policy changes, and commercial payer guideline revisions to assess client impact and inform advisory recommendations. Prepare structured analytical exhibits, workpapers, and client‑facing deliverables including reports, presentations, and financial summaries. Collaborate with the Managing Director and cross‑functional engagement teams to execute project workplans, ensure analytical accuracy, and deliver quality client outcomes. Support business development activities including data‑driven proposal development, market research, and benchmarking analysis. Applications for this evergreen opportunity will be accepted through Dec 31, 2026. Riveron Consulting is an Equal Opportunity Employer and believes that we are stronger together through our diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law. #J-18808-Ljbffr Riveron