Associate Revenue Cycle Analyst - Prior Authorizations

The Associate Revenue Cycle Analyst will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, conducting trend analysis, driving performance in operations related to prior authorizations and reimbursement, and providing direction and oversight of processes impacting cash collections.

Job Responsibilities:

• Serves as the primary source of knowledge for the designated revenue cycle function.

• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.

• Responsible for ensuring appropriate configuration of systems and workflows for designated revenue cycle function.

• Establishes an ongoing working relationship with other departments impacting revenue cycle performance.

• Works closely with the vendor operations teams to oversight operations activity that directly impact the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.

• Tracks on-going performance of revenue cycle metrics and activities to ensure goals are met.

• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.

• By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.

• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.

• Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy.

• Develops, manages and monitors successful completion of implementation and project plans.

• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.

• Continuously seek new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

• Develops, manages and monitors successful completion of implementation and project plans.

• Responsible for ongoing denial trend research and analysis, including evaluation of clinical, coding and reimbursement policies, and translating that information into action plans that drive end-to-end performance improvement.

Qualifications: 

• Bachelor’s Degree in business or healthcare related field of study, or equivalent years of work experience 

• At least 4-6 years of experience in medical billing and Insurance collections.

• Advanced knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

• Experience with Business Intelligence tools (such as PowerBI or Tableau) preferred. 

Required Knowledge, Skills and Abilities:

• Proficiency with medical billing systems, Microsoft Excel, medical terminology and basic procedure coding knowledge.

• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.

• Strong knowledge of prior authorization processes and full revenue cycle. 

• Strong communication (verbal and written), organizational, problem solving and team player skills.

• Ability to navigate across multiple customer demands and balance competing priorities successfully.

• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner.

• Ability to independently solve complex problems using critical thinking skills.

• Maintains confidentiality of sensitive information.

• Analytical skills required.

• Ability to think critically and identify the global impact across the revenue cycle with a solution oriented approach.

• Ability to develop, implement and produce complex analysis and reports.

• Ability to motivate and create a team environment, prioritize work distribution, exceptional organizational and time management skills.

• Requires advanced project management skills, must be able to manage multiple projects.