PDL Revenue Operations Analyst

About the role

Pacific Diagnostic Laboratories seeks a Revenue Operations Analyst responsible for the overall day-to-day operations of denials management, appeals, self-pay inventory, claims write-offs, client edits, client portal usage, payer policy changes, AR aging across all payer classes, insurance eligibility, and insurance discovery trends.

Actively oversees, maintains, and communicates denials and appeals activity to clients and internal stakeholders. Provides guidance and direction to the team to ensure the department maintains or exceeds goals, including total AR collections, credit balances, number and amount of edits and denials, identifies emerging trends in claims payments, and assesses expected vs. actual reimbursement. Ensures all activities are performed in compliance with Cottage Health (CH) and PDL policies, procedures, and Federal and State regulations. Assists in recruitment, retention, training, and work allocation.

Responsibilities

• Oversee and manage day-to-day operations of denials management and appeals.
• Maintain and communicate denials and appeals activity to clients and internal stakeholders.
• Guide the team to meet or exceed department goals, including AR collections, credit balances, edits, and denials.
• Identify emerging trends in claims payments and assess expected vs. actual reimbursement.
• Ensure compliance with Cottage Health and PDL policies, as well as Federal and State regulations.
• Assist in recruitment, retention, training, and work allocation for the team.

Requirements

• Bachelor's degree or equivalent Lab Revenue Cycle Management (RCM) work experience of 6 years.
• Five years of Lab RCM experience, preferably in a multi-facility environment, including three years of progressive responsibility in healthcare revenue cycle.
• Experience working with legal consent policy and procedures, and payer contracting and policies.
• Understanding of ICD-10 coding for Lab CPTs, working payer denials, and appeal processes.
• Expertise in healthcare insurance eligibility, verification, and claims filing procedures.
• Proficiency in Microsoft Office suite, with an emphasis on Excel and PowerPoint.
• Ability to analyze data to identify trends and opportunities for process improvement.

Preferred Qualifications

• MS-Office 365 proficiency.
• Minimum of five years of related work experience.
• Knowledge of medical terminology.

About Us

Cottage Health is a leading acute care hospital system located on the central coast of California, widely known for superior patient care, innovation, medical research, and education. Our health system operates primarily in Santa Barbara, CA, since 1888, and consists of three acute care hospitals, a Rehabilitation Hospital, multiple clinics, and a multi-site Urgent Care system. Our mission is to serve the central coast communities with excellence, integrity, and compassion.

Pay

Pay for non-physician positions is determined based on related years of experience and internal equity. Eligible employees may also receive additional forms of compensation, including shift differentials, on-call pay, incentive pay, and bonus opportunities, where applicable. Manager and above positions may participate in Cottage Health’s annual management incentive program.