Revenue Cycle Analyst - (**This is an ONSITE/Hybrid Position)**

Monday through Friday, 8:00am–4:30pm or 6:00am–2:30pm.

Pay

The pay range is $75,000–$95,000 per year, depending on relevant years of experience.

Benefits

We offer a competitive package of employee benefits for 30- to 40-hour week positions. You will receive a defined contribution of up to $15,433.08 per year (prorated for part-time employees working fewer than 40 hours per week) to purchase benefits of your choice on a cafeteria-plan basis. Any unused portion of this contribution is paid as taxable earnings.

• Retirement plan: generous employer match starting at 4% after one year of employment.
• Paid time off: up to 25 days of vacation per year, 6 days of sick time per year, and 12 paid holidays.
• Medical benefits:
  • Kaiser plans ranging from a $0-deductible plan with $15 copay to a $3,400-deductible plan with Health Savings Account.
  • Sutter Health plans from $0-deductible to $2,500-deductible.
• Dental benefits: 1 dental HMO and 2 PPOs through Guardian.
• Vision benefits: 2 options from Guardian VSP: a standard vision plan and an enhanced vision plan.

About the role

The Revenue Cycle Analyst is responsible for the full lifecycle management of reimbursement activities, including billing, denial management, accounts receivable follow-up, payment reconciliation, reimbursement analysis, and collections. This position serves as a subject-matter expert in behavioral-health billing regulations, Santa Clara County behavioral-health reimbursement requirements, Medi-Cal claim methodologies, managed-care billing, and electronic health record systems such as myAvatar. Working independently, the analyst proactively identifies revenue-cycle issues, researches root causes, develops corrective actions, and collaborates with clinical, program, finance, quality, and operational teams to maximize reimbursement and ensure regulatory compliance. The role functions as a high-level individual contributor with ownership of assigned revenue-cycle processes from issue identification through final resolution.

Responsibilities

• Revenue Cycle Management
  • Manage behavioral-health billing and reimbursement processes from claim generation through payment collection.
  • Analyze and resolve complex billing issues, claim edits, denials, underpayments, and rejected claims.
  • Research reimbursement discrepancies and implement corrective actions to prevent recurring issues.
  • Monitor claim-submission activity and ensure timely filing compliance.
  • Conduct comprehensive accounts-receivable analysis and prioritize collection activities.
  • Follow claims from point of service through final payment resolution.
• Denial Management
  • Independently investigate and resolve denied or rejected claims.
  • Identify root causes of denial trends and develop corrective action plans.
  • Prepare and submit appeals and supporting documentation.
  • Track appeal outcomes and recovery performance.
  • Partner with clinical, quality, and program staff to reduce future denials.
• Financial Analysis and Reconciliation
  • Create, review, and post payments, adjustments, transfers, and contractual allowances.
  • Validate reimbursement accuracy based on payer contracts and county funding requirements.
  • Analyze revenue trends and billing patterns.
  • Conduct bi-weekly accounts-receivable analytics and aging reviews.
  • Prepare financial and operational reports with recommendations for leadership.
• Behavioral Health and County Billing Expertise
  • Maintain expertise in Medi-Cal Specialty Mental Health Services, Santa Clara County Behavioral Health Services requirements, CalAIM initiatives, behavioral-health documentation requirements, managed-care billing guidelines, and federal and state reimbursement regulations.
  • Interpret county claiming requirements and communicate operational impacts to leadership and program teams.
  • Collaborate with county representatives and commercial payers to resolve reimbursement issues.
• EHR and System Support
  • Serve as a subject-matter expert for revenue-cycle processes within myAvatar EHR, Inovalon, and other behavioral-health EHR platforms.
  • Identify workflow gaps impacting reimbursement.
  • Participate in system implementation, testing, upgrades, and optimization projects.
  • Develop recommendations to improve billing efficiency and revenue capture.
• Revenue Integrity and Compliance
  • Conduct audits of clinical documentation and billing data to ensure claim accuracy.
  • Identify compliance risks related to billing and reimbursement activities.
  • Partner with clinical and quality teams to improve documentation supporting medical necessity and billing requirements.
  • Ensure compliance with federal, state, county, payer, and agency regulations.
• Cross-Functional Collaboration
  • Act as a billing and reimbursement resource for program managers, leadership, clinicians, and finance staff.
  • Train staff on reimbursement requirements, documentation standards, and billing workflows.
  • Participate in process-improvement initiatives designed to increase cash collections and reduce denials.
  • Lead revenue-cycle projects and special assignments as directed.

Requirements

• Bachelor’s degree in Accounting, Finance, Business Administration, Health Information Management, Healthcare Administration, or related field; or equivalent combination of education and relevant healthcare revenue-cycle experience.
• Minimum 3–5 years of healthcare billing, reimbursement, revenue-cycle, or accounts-receivable experience.
• Experience independently resolving claim denials, payment variances, and aging accounts receivable.
• Valid California driver’s license, current automobile insurance, and a good driving record, as documented by a DMV report.

Preferred Qualifications

• Experience billing Santa Clara County Behavioral Health programs.
• Experience with Specialty Mental Health Services (SMHS).
• Experience with Medi-Cal, Medicare, and Managed Care reimbursement.
• Experience using myAvatar EHR.
• Experience interpreting payer contracts and reimbursement processes.
• Experience performing payment reconciliation and revenue analysis.
• Experience with behavioral health, mental health, substance-use disorder, or community healthcare services.

Skills

• Technical Expertise
  • Advanced understanding of revenue-cycle management, healthcare accounts receivable, denial management, behavioral-health billing, Medi-Cal billing requirements, payment posting, managed-care reimbursement, financial reconciliation, and revenue-integrity principles.
• Analytical Skills
  • Strong root-cause analysis and problem-solving abilities.
  • Ability to independently research and resolve complex reimbursement issues.
  • Ability to identify trends and recommend operational improvements.
  • Strong quantitative and accounting skills.
• Systems Proficiency
  • Advanced Microsoft Excel skills, including pivot tables, VLOOKUP/XLOOKUP, and financial-analysis functions.
  • Experience with myAvatar, claims clearinghouses (ChangeHealthcare/Inovalon), revenue-cycle processes, and financial-report creation and analysis.
• Communication
  • Ability to effectively communicate reimbursement and financial concepts to both operational and clinical staff.
  • Strong written and verbal communication skills.
  • Ability to influence process improvements across departments.
• Core Competencies
  • Revenue-cycle expertise, accountability, critical thinking, financial acumen, problem solving, data analysis, attention to detail, customer service, regulatory compliance, process improvement, initiative, independent judgment, and collaboration.

Physical Requirements

Hearing and talking on telephone and in person; standing, walking, sitting, pinching, and finger flexion are required constantly (over two-thirds of the workday). Lifting, carrying, pushing, pulling, bending, stooping, crouching, kneeling, and twisting are required occasionally (under one-third of the workday). Balancing, climbing, and crawling are generally not required.