PathGroup

Compensation

Full Description

Job Summary: We are seeking a Revenue Cycle Analyst who combines strong analytical skills with a passion for improving operational performance. In this role, you will analyze payer data, resolve claim denials, and transform insights into actionable strategies that drive revenue growth.   The Revenue Cycle Analyst is charged with coordinating the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. This includes interpreting payment and denial data down to the line-item detail, identifying payer and coding trends, risks, and opportunities, to implement operational or systematic improvements.   You will have autonomy and ownership of your assigned payer portfolio in a full-time, remote capacity.   JOB RESPONSIBILITIES:   * Analyze revenue cycle data across internal systems and payer portals to identify trends, patterns, and performance gaps to ensure timely and accurate reimbursement. * Monitor claims, cash collections, denials, reimbursements, and payer behavior through daily and weekly reporting. * Track KPIs such as days in A/R, denial rates, net collections, reimbursement timelines, credit balances, and payor policies such as NCD, LCD and other coverage policies impacting revenue. * Responsible for prioritizing and managing to resolution denied claims with third party payors. Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility, and authorization requirements. Identify appeal opportunities, providing compelling appeal language for third party payers. * Conduct root-cause analysis for denials, rejections, underpayments, and delayed payments, recommending actionable solutions. Maintains action plans for improvements. * Partner closely with internal stakeholders to improve clean-claim rates, streamline workflows, and enhance overall efficiency. * Create SOP’s, process flows and documentation to enhance denial processing efficiency. * Partner with Managed Care on payer negotiations and behavior. * Support ad hoc data requests and cross-functional initiatives for revenue cycle leadership. * Compiles, maintains, and distributes reports to management on success of appeals and root cause analysis. Serves as subject matter expert of payer requirements. Qualifications EDUCATION & LICENSURE:   * Bachelor’s degree in Healthcare Administration, Business, Analytics, or equivalent experience.   REQUIREMENTS:   * Bachelor's degree in related field, or equivalent work experience. * 4+ years of experience in healthcare revenue cycle analytics, financial analysis, or operational data analysis. * Direct experience with claims analytics, denial management, and payer performance reporting. * Knowledge of insurance billing, Medicare claims, audit processes, compliance standards, and HIPAA regulations. * Experience with laboratory billing preferred. * Advanced skills with Microsoft applications which may include Outlook, Word, Excel/Smartsheet’s, PowerPoint and other web-based applications. * Create SOP’s and process flow mappings using Visio. * Familiarity with Xifin billing system a plus.   ABILITIES: * Problem Solving: Ability to address problems that are highly varied, complex, and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues. * Strong analytical skills with the ability to translate data into insights and operational recommendations. * Solid understanding of healthcare RCM processes (insurance verification, coding, billing, payment posting, A/R follow-up). * Clear, concise communication skills—comfortable explaining complex findings to non-technical stakeholders. * Highly organized, adaptable, and comfortable working in a dynamic, fast-growing environment. * Applies working knowledge in the application of concepts, principles, and technical capabilities to perform varied tasks. * Basic understanding of EHR systems and functionality. * Comfortable performing analysis and adept at data retrieval via analysis tools.