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

About the role

The Revenue Cycle Analyst is responsible for the full lifecycle management of Momentum’s reimbursement activities, including billing, denial management, accounts receivable follow-up, payment reconciliation, reimbursement analysis, and collections. This position will be 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 my Avatar. Working independently, the Revenue Cycle Analyst proactively identifies revenue cycle issues, researches root causes, develops corrective actions, and collaborates with clinical, program leads, program administrators, finance, quality, and operational teams to maximize reimbursement and ensure regulatory compliance. This 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; 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, 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.