Revenue Cycle Analyst

Job Summary

The Revenue Cycle Specialist supports the daily operations of the revenue cycle department, analyzing billing data, investigating denial trends, and processing claim corrections, in order to optimize reimbursement rates, ensure data accuracy, and assist management in financial reporting.

Essential Job Functions

• Analyze claim denials and rejection trends, reviewing explanations of benefits and coordinating with coding teams to submit timely appeals, in order to recover revenue and minimize uncollectible debt.
• Generate and maintain routine financial and operational reports, extracting data from the Electronic Health Record and tracking Key Performance Indicators (KPIs), in order to provide visibility on revenue performance to the leadership team.
• Assist in the maintenance of payers, charge master and fee schedules, updating system configurations and vendors based on CMS guidelines and payer contract changes under the Manager's supervision, in order to ensure billing compliance and claim accuracy.
• Audit patient accounts and billing records, verifying demographic and insurance information against payer requirements and internal policies, in order to prevent front-end rejections and ensure clean claim submission.
• Collaborate with the RCM vendors and internal departments, providing specific case examples and documentation for issue resolution, in order to facilitate smooth billing operations and efficient problem-solving.
• Daily interaction with Operations team.
• Payment posting, tracking, and reconciliation.
• Responsible for RCM workflow review and updates for center operations.
• Prepare and generate ADHOC reports in a daily, monthly, and quarterly basis.
• Identify Revenue cycle bottlenecks and recommend strategies for optimization.