Revenue Cycle Management Analyst

RCM Analyst

Under the supervision of the Director of Revenue Cycle Management, the RCM Analyst is responsible for analyzing, monitoring, and optimizing all aspects of the healthcare revenue cycle to maximize reimbursement, improve operational efficiency, and ensure regulatory compliance. This position works collaboratively with billing, coding, clinical operations, finance, and payer representatives to identify trends, resolve revenue issues, and implement process improvements. The analyst also oversees provider payer credentialing and enrollment activities to ensure timely participation with commercial and government insurance plans.

Provider Credentialing & Payer Enrollment

• Coordinate provider credentialing and recredentialing with commercial insurance carriers, Medicare, Medicaid, and other government payers.
• Prepare, submit, and monitor provider enrollment applications.
• Maintain provider credentialing files and documentation.
• Ensure timely renewals of licenses, certifications, malpractice insurance, DEA registrations, and CAQH profiles.
• Maintain provider information within CAQH and payer portals.
• Track credentialing application status and resolve enrollment issues with payers.
• Verify provider participation status with insurance plans.
• Maintain payer rosters and provider directories.
• Coordinate provider onboarding to minimize delays in billing.
• Monitor credentialing expiration dates and ensure uninterrupted payer participation.
• Respond to payer requests for additional documentation.
• Maintain compliance with NCQA, CMS, Medicare, Medicaid, and payer credentialing standards.

Revenue Cycle Management

• Collaborate with billing companies to ensure they have all provider enrollments, facility credentialing and insurance needs met (COI's).
• Liaison between hospital facilities and billing company via EHR to ensure all information is received to properly code and bill for services rendered at the hospitals.
• Analyze payer contracts and reimbursement methodologies. Stay apprised of market rates and current CMS reimbursement.
• Evaluate workflows and recommend process improvements.
• Perform ad hoc RCM duties as needed.

Compliance

• Maintain compliance with HIPAA regulations.
• Stay current with CMS regulations and payer policy updates.
• Assist with internal and external audits.

Collaboration

• Serve as a liaison between providers, billing staff, credentialing organizations, and insurance payers.
• Take part in training and education regarding revenue cycle best practices.
• Participate in cross-functional process improvement initiatives.

Reporting Relationships :

The Revenue Cycle Analyst reports to the Director of Revenue Cycle Management.

Specifications:

Knowledge, Skills & Abilities:

1. Minimum 3 years of RCM experience with emphasis on insurance company knowledge, payer enrollments, and credentialing
2. Experience in a professional fee and/or facility setting
3. Deep understanding of current credentialing guidelines, reimbursement guidelines, and documentation requirements
4. Strong verbal and written communication skills
5. Computer skills, including knowledge of Excel, Word, and Outlook.