Revenue Cycle Analyst

Revenue Cycle Analyst

The Revenue Cycle Analyst will be an integral part of the Company's Revenue Cycle Team and is responsible for providing strong analytical assessments, reporting, and data-driven operational support for multiple aspects of revenue cycle operations within the Centralized Billing Office (CBO). This position will collaborate with subject matter experts to support daily business operations through data-driven decisions, ensuring timely and accurate billing, performance improvement, reconciliation, benchmarking, and reporting.

Essential Job Functions

• Runs, reviews, interprets, analyzes, and validates large, complex datasets from various health information sources (e.g., claims, contracts, operational data).
• Analyzes reimbursement by utilizing knowledge of group payer contracts, payer policies, member benefits, and comparing actual to expected reimbursement.
• Reviews, analyzes, interprets, and reconciles "Explanation of Benefits" (EOBs) and payer remittances to identify denial trends and reduce controllable rejections.
• Analyzes data trends, conducts root cause analysis, and performs denials analysis to identify solutions and reduce rejections.
• Gathers and analyzes revenue cycle data to provide ad hoc information to internal and external stakeholders.
• Ensures data integrity across the revenue cycle and organization to support decision-making and actionable insights.
• Applies knowledge of hospital billing, medical coding, and contractual terms to analyze claim denials and communicate insurance policy changes to stakeholders.
• Updates and maintains fee schedules and reimbursement models for Medicare and commercial insurance payers.
• Conducts revenue cycle analysis and provides trends as needed by Revenue Cycle leadership team to identify improvement opportunities.
• Contributes to internal initiatives and projects related to Revenue Cycle data, analytics, and reporting.
• Performs data extraction and manipulation using BI tools, Excel, and other query tools within practice management systems.
• Has detailed knowledge of core Revenue Cycle systems and all bolt-on software solutions.
• Assist in creating and monitoring models that connect strategies to measures of performance that ensure successful reporting of revenue cycle data. Collaborate with various IT departments, Reporting teams, Revenue Recognition, and Managed Care to develop dashboards and metrics tracking.
• Independently performs complex research, compiles financial analyses, and develops detailed spreadsheets; prepares in?depth analyses focused on accuracy, reliability, and timeliness; provides/presents interpretation of findings to revenue cycle leaders.
• Develops analyses and reports to support key initiatives, including identification and recommendation of improvements to existing processes, with timely follow-through as appropriate.

Other Job Functions

• Participate in cross-functional business projects and perform ad hoc analysis as required
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned

Basic Qualifications

• Bachelor's degree or an equivalent combination of education and experience may be considered, required.
• 3+ years of related analyst experience with a preference for revenue cycle, Hospital billing, and third-party payer reimbursement.
• Advanced skills in using Excel and BI data applications to maneuver through large volumes of data, required.
• Experience with inpatient and outpatient billing requirements (UB-04), required.
• Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self-pay reimbursement concepts and overall operational impact.
• Knowledge of third-party payer reimbursement methodologies/contracts and CMS Medicare, required. Texas state Medicaid reimbursement, a plus.
• Demonstrated advanced skills in A/R management, problem assessment, and resolution and collaborative problem-solving in complex, interdisciplinary settings.
• Ability to work independently, follow through, and handle multiple tasks simultaneously with minimal supervision.
• Must be a motivated individual with a positive and exceptional work ethic.
• Strong knowledge of electronic billing systems for front-end and back-end functions and the willingness to learn new systems, applications, and programs.
• Excellent analytical skills: attention to detail, critical thinking ability, decision-making, and researching skills in order to analyze a question or problem and reach a solution.
• Reasoning skills and ability to articulate logic behind decisions.