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Revenue Cycle EDI Systems Analyst

As a Revenue Cycle EDI Systems Analyst, you will report to the VP, RCM. You will be responsible for supporting, monitoring, and optimizing revenue cycle systems utilized by the FSU. You will ensure accurate and timely billing, compliance with regulatory requirements, and efficient workflows for receivable management activities. The Revenue Cycle Systems Analyst acts as a liaison between the FSU and other internal teams, as well as external business partners, to streamline revenue cycle performance and enhance system functionality.

Key Responsibilities

System Management & Optimization:

• Support and configure revenue cycle applications utilized for billing and claims management.
• Identify and implement process improvements to reduce denials and accelerate reimbursements.
• Collaborate with FSU, IT and vendors to troubleshoot and resolve system issues and coordinate upgrades or integrations.

Data Analysis & Reporting:

• Monitor revenue cycle metrics such as errors, rejections and denial rates.
• Utilize dashboards and reports to track and identify billing and collections trends.
• Provide actionable insights to leadership for decision-making.

Compliance & Quality Assurance:

• Ensure systems align with CMS, HIPAA, and payer requirements.
• Respond to internal and external audit and data requests.
• Support staff with system use and system issues.

EDI Transaction Management:

• Manage, analyze, and optimize electronic data transactions (837, 835, 270/271, etc.) between the FSU and external vendors.
• Collaborate with clearinghouses and payers to resolve transmission, billing and adjudication errors.
• Ensure timely submission of claims and receipt of remittance advice.

Cross-Functional Collaboration:

• Partner with internal and external teams to ensure system functionality supports departmental and company goals.
• Work with finance to reconcile payments and resolve discrepancies.
• Support and train staff on System functionality, EDI processes and best practices.

Process Improvement:

• Evaluate current workflows and recommend enhancements to improve efficiency, reduce costs, and ensure accurate and timely billing.
• Collaborate with cross-functional teams to implement new procedures and track effectiveness.

Requirements

• 3 or more years of experience in healthcare revenue cycle and EDI, preferably in home health or post-acute care.
• Strong knowledge of HIPAA transactions (837, 835, 270/271, etc.), EMR/EHR systems, and clearinghouse platforms.
• Analytical skills with proficiency in Microsoft Office applications.
• Understanding of healthcare regulations, reimbursement models, and compliance standards.
• Excellent problem-solving, communication, and organizational abilities.

Preferred Requirements

• Bachelor's degree in Health Information Management, Computer Science, Business Administration, Healthcare Management, Data Analytics or related field, or equivalent experience.
• Experience with revenue cycle automation tools and workflow optimization.
• Familiarity with Medicare/Medicaid billing processes specific to home health.
• Proficiency in file transfer software.
• Project management or process improvement experience.

Additional Information:

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours: 40

Pay Range: $60,800 - $82,900 per year

Description of Benefits: Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.