Analyst, Revenue Cycle Management – Managed Care

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and sustain reporting on revenue cycle performance, encompassing accounts receivable, collections, denials, aging, and reimbursement trends.

• Detect performance gaps and potential risks while proposing enhancements to financial results.

• Examine denial trends, payment discrepancies, and collection patterns to uncover root causes and opportunities for improvement.

• Track revenue cycle metrics and deliver insights to operational leadership.

• Analyze payer contracts, reimbursement rates, fee schedules, and payment methodologies.

• Identify and quantify reimbursement inconsistencies, underpayments, and incorrect applications of contract rates.

• Create financial models for payer contract negotiations, renewals, and adjustments in reimbursement.

• Assess payer mix, service line performance, and reimbursement scenarios.

• Assist budgeting, forecasting, growth initiatives, portfolio performance, and strategic analysis with Finance and Corporate Development.

• Analyze claims, reimbursement, procedure-level, and specialty data to formulate projections and identify risks.

• Convert complex datasets into actionable recommendations for business and operational leaders.

• Ensure the quality and consistency of payer, contract, and reimbursement data.

• Enhance reporting, minimize manual processes, and increase analytical efficiency.

• Uphold confidentiality and adhere to HIPAA and data governance standards.

• Utilize AI-powered tools, automation, and advanced analytics to expedite analysis and enhance reporting.

• Assess workflows and devise scalable solutions that bolster accuracy and consistency.

• Confirm the validity of automated and AI-generated outputs prior to their application in financial analysis or recommendations.

• Implement safeguards when managing sensitive financial, payer, or protected healthcare data.

⛳️ Requirements

• A bachelor's degree in Finance, Accounting, Healthcare Administration, Business Analytics, Economics, Information Systems, or a related discipline.

• Experience in healthcare revenue cycle management, managed care, reimbursement analysis, healthcare finance, or a closely related analytical role.

• Proficient understanding of healthcare revenue cycle processes, including claims, payment posting, denials, collections, and accounts receivable.

• Knowledge of payer reimbursement methodologies, contract rates, and reimbursement variance analysis.

• Experience in analyzing financial or operational data and converting insights into actionable recommendations.

• Advanced skills in Microsoft Excel, including formulas, lookups, pivot tables, data reconciliation, and analysis of extensive datasets.

• Strong analytical judgment, meticulous attention to detail, and effective communication skills with cross-functional stakeholders.

• Awareness of healthcare data confidentiality and HIPAA regulations.

• Experience using AI, automation, business intelligence, or workflow tools to enhance analysis and reporting.

• Capability to assess new technologies and thoughtfully apply them to practical business challenges.

• Sound judgment in validating AI-generated outputs and managing sensitive healthcare information.

• Preferred: Experience supporting ambulatory surgery centers, hospital outpatient departments, physician practices, or multisite healthcare organizations.

• Preferred: Experience with payer contract modeling, fee schedule analysis, reimbursement methodologies, or evaluating contract performance.

• Preferred: Experience in analyzing accounts receivable, denials, collections, payment variances, or other revenue cycle performance metrics.

• Preferred: Familiarity with healthcare financial reporting, forecasting, and dashboard creation.

• Must be eligible to work in the United States; visa sponsorship inquiry is included in the application.

🏝️ Benefits

• Compensation varies based on work location, relevant skills, experience, education or training, and company and individual performance.

• Remote work arrangement.