Behavioral Health Claims Analyst

Modern Recovery Network

8d•Onsite

About The Position

This role focuses on Revenue Cycle Management, Data Analytics & Reporting, and Leadership & Process Improvement within the behavioral health sector. The analyst will lead the end-to-end revenue cycle process, monitor key metrics, ensure compliance, and oversee claim submissions. A significant part of the role involves designing and maintaining reports, analyzing data to identify trends and opportunities, and performing root cause analysis on various financial and operational issues. The position also requires leadership in mentoring staff, establishing goals, and driving process improvement initiatives, including identifying automation opportunities.

Requirements

5+ years of experience in revenue cycle management, healthcare finance, medical billing, or related fields.
2+ years of experience in data analytics, business intelligence, or reporting.
Experience managing teams and cross-functional projects.
Strong understanding of healthcare reimbursement methodologies, payer regulations, and revenue cycle operations.
Advanced proficiency in Microsoft Excel.
Knowledge of healthcare billing systems, EHR platforms, and practice management software.
Strong analytical, problem-solving, and reporting skills.

Nice To Haves

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Data Analytics, Information Systems, or a related field.

Responsibilities

Lead and manage the end-to-end revenue cycle process, including patient registration, charge capture, coding, billing, collections, payment posting, and denial management.
Monitor key revenue cycle metrics and implement strategies to improve cash flow and reduce accounts receivable days.
Ensure compliance with payer regulations, contractual requirements, and industry standards.
Oversee claim submission processes and resolve billing issues, denials, and underpayments.
Conduct regular audits of billing and coding activities to ensure accuracy and compliance.
Design, develop, and maintain dashboards, reports, and performance scorecards for revenue cycle operations.
Analyze financial, operational, and claims data to identify trends, risks, and improvement opportunities.
Monitor key performance indicators (KPIs) such as clean claim rate, denial rate, collection rate, net collection percentage, and days in accounts receivable.
Perform root cause analysis on denials, payment variances, and revenue shortfalls.
Create predictive models and forecasting reports to support strategic decision-making.
Extract, validate, and analyze data from billing systems, EHRs, and other databases.
Present analytical findings and recommendations to leadership teams.
Support process improvement initiatives through data-driven insights.
Supervise and mentor revenue cycle staff, providing training and performance management.
Establish departmental goals and monitor progress toward organizational objectives.
Lead revenue cycle improvement projects and system optimization initiatives.
Identify automation opportunities to improve operational efficiency and reporting accuracy.