Revenue Cycle Compliance Analyst

About the role

The Revenue Cycle Compliance Analyst is responsible for monitoring and auditing revenue cycle operations to ensure compliance with federal and state regulations, payer requirements, and organizational policies. This role supports billing integrity, regulatory compliance and revenue optimization through data analysis, auditing, and collaboration with operational departments.

Responsibilities

• Maintains compliance with CMS, Medicare, Medicaid, and commercial payer regulations.
• Serves as a key resource for the annual external audit and performs periodic ongoing audits of billing, charging, coding, and documentation practices.
• Reviews service line billing workflows for adherence to regulatory and organizational policies.
• Analyzes claim denials, RTPs, and payer edits to identify trends and recommend corrective actions.
• Assists with compliance related to Price Transparency, Good Faith Estimates, and No Surprises Act requirements.
• Collaborates with coding, billing, HIM, finance, and clinical departments to resolve billing compliance issues.
• Interprets and researches regulatory updates, payer guidelines, and reimbursement changes impacting revenue cycle operations.
• Prepares audit findings, compliance reports, and recommendations for leadership and operational teams.
• Supports education and training efforts for staff related to billing compliance, documentation standards, and regulatory requirements.
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Requirements

A minimum of 5 years related experience is required. A bachelor's degree in a related field is preferred.

Qualifications

This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Physical Demands

Sit: Frequently (34-66%)
Stand: Occasionally (5-33%)
Walk: Occasionally (5-33%)
Squat/Crouch/Kneel: Rarely (1-4%)
Reach: Frequently (34-66%)
Handle/Finger/Feel: Continuously (67-100%)
See: Continuously (67-100%)
Hear: Continuously (67-100%)
Lift - Floor to Waist Level: Sedentary (Carry: Sedentary (Push/Pull: Sedentary (Slide/Transfer: Not Applicable)

Working Conditions

Indoor: Continuously (67-100%)

Driving Requirement

Infrequent Driver