REVENUE CYCLE ANALYST II

About the role

This position is responsible for CenterLight’s billing and revenue cycle analysis, reconciliation, and operational procedures while maintaining adherence to DOH and CMS guidelines. The role independently manages day-to-day revenue cycle operations, reports on revenue cycle functions, and provides guidance to Revenue Cycle Analyst I staff.

Responsibilities

• Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
• Enter and independently reconcile insurance and member payments to A/R.
• Perform full analytics on all revenue operations for all lines of business at CenterLight.
• Perform analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
• Independently investigate and resolve Enrollment/Intake discrepancies for correction/rebilling.
• Coordinate with Enrollment on PDE rejections and assist the Enrollment team with CMS-related issues.
• Coordinate with Enrollment on MSP letters and correction of discrepancies in ECRS.
• Identify members with Surplus, NAMI, or Pool Trust balances and resolve related issues.
• Work with the Enrollment/Intake team to resolve eligibility issues.
• Perform monthly MMR analysis and work with the CMS MAPD Helpdesk to open and resolve tickets.
• Coordinate with Dialysis providers to obtain 2728 forms and work with the CMS MAPD Helpdesk to activate member ESRD indicators.
• Prepare monthly GL entries related to revenue.
• Assist Actuarial with data analytics as needed.
• Develop and maintain financial reporting and analytics in Tableau/Power BI (including KPI dashboards) used by senior leadership to track actual results vs. target.
• Prepare ad hoc financial modeling, analysis, and projections.
• Serve as a resource and informal mentor to Revenue Cycle Analyst I staff on daily tasks, tools, and procedures.
• Contribute to process improvement initiatives and document standard operating procedures (SOPs).
• Create SQL queries and stored procedures for use by other members of the team.
• Develop processes to identify revenue-enhancing opportunities.
• Work on special projects as assigned.

Qualifications

• Bachelor’s degree required.
• Certified Professional Coder a plus.
• 3–5 years of healthcare experience in a managed care setting required.
• Proficiency in data analytics, i.e., SAS, SQL required.
• Claims adjudication and understanding of claims PPS strongly preferred.
• Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting required.
• Knowledge of CPTs, ICD-9/ICD-10, HCPC, DRG, Revenue, RBRVS.
• Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.
• Effective oral, written, and interpersonal communication skills required.
• Ability to multitask efficiently, effectively, and timely.
• Strong organizational skills and work ethic.
• Detail-oriented, professional, collaborative, and a great team player.

Physical Requirements

• Standing up to 6 hours a day.
• Sedentary position for up to 6–8 hours a day for consecutive periods.
• Lifting/pushing/pulling up to 50 pounds using OSHA guidelines.
• Ability to bend or squat to perform essential functions.
• Ability to safely maneuver stairs, climb up/down, and walk to access work areas.
• Agility and fine motor skills to operate equipment, devices, and tools (e.g., typing, use of supplies).
• Visual ability to read documentation and type/write with accuracy.
• Audio hearing and motor skills to listen, document, and speak clearly and accurately.
• Cognitive ability to demonstrate good decision-making, reasoning, and analysis.