REVENUE CYCLE ANALYST II

C2Q Health Solutions•New York, NY

3d•$80,000 - $90,000

About The Position

This position is responsible for CenterLight’s billing and revenue cycle analysis, reconciliation, and operational procedures while maintaining adherence to DOH and CMS guidelines. The Revenue Cycle Analyst II independently manages day-to-day revenue cycle operations, reports on revenue cycle functions, and provides guidance to Revenue Cycle Analyst I staff. The role includes weekly billing, payment reconciliation, revenue analytics across CenterLight lines of business, resolving enrollment and eligibility discrepancies, coordinating with Enrollment and CMS support, preparing revenue-related general ledger entries, and supporting actuarial analytics. The analyst develops and maintains financial reports and dashboards in Tableau or Power BI, prepares ad hoc financial models and projections, contributes to process improvements and standard operating procedures, creates SQL queries or stored procedures, and works on initiatives to identify revenue-enhancing opportunities. Other special projects may be assigned. The position is scheduled Monday through Friday, 8:30 a.m. to 5:30 p.m., for 40 hours per week. The job description lists physical requirements including standing, sitting, lifting or pushing/pulling items up to 50 pounds, bending, squatting, using stairs and walking, operating equipment, visual and audio tasks, communication, and cognitive analysis.

Requirements

Bachelor’s degree required.
Three to five years of healthcare experience in a managed care setting required.
Proficiency in data analytics, such as SAS and SQL, required.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting required.
Knowledge of CPT, ICD-9/ICD-10, HCPC, DRG, Revenue, and RBRVS.
Proficiency in Microsoft Excel, Word, and PowerPoint.
Experience using a claims processing system or comparable database software.
Effective oral, written, and interpersonal communication skills.
Ability to multitask efficiently, effectively, and in a timely manner.
Strong organizational skills and work ethic.
Detail-oriented, professional, collaborative, and an effective team player.
Ability to meet the listed physical requirements, including lifting or pushing/pulling up to 50 pounds and performing the specified standing, sitting, mobility, dexterity, visual, hearing, communication, and cognitive tasks.

Nice To Haves

Certified Professional Coder certification.
Claims adjudication experience and understanding of claims PPS are strongly preferred.

Responsibilities

Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
Enter and independently reconcile insurance and member payments to accounts receivable.
Perform analytics on revenue operations across all CenterLight lines of business.
Analyze MMR and 820/834 files and reconcile payments received to billing files.
Investigate and resolve Enrollment/Intake discrepancies for correction or rebilling.
Coordinate with Enrollment on PDE rejections and assist with CMS-related issues.
Coordinate with Enrollment on MSP letters and correction of discrepancies in ECRS.
Identify members with Surplus, NAMI, or Pool Trust balances and resolve related issues.
Work with the Enrollment/Intake team to resolve eligibility issues.
Perform monthly MMR analysis and work with the CMS MAPD Helpdesk to open and resolve tickets.
Coordinate with dialysis providers to obtain 2728 forms and work with the CMS MAPD Helpdesk to activate member ESRD indicators.
Prepare monthly general ledger entries related to revenue.
Assist Actuarial with data analytics as needed.
Develop and maintain financial reporting and analytics in Tableau or Power BI, including KPI dashboards for senior leadership to track actual results against targets.
Prepare ad hoc financial modeling, analysis, and projections.
Serve as a resource and informal mentor to Revenue Cycle Analyst I staff on daily tasks, tools, and procedures.
Contribute to process improvement initiatives and document standard operating procedures.
Create SQL queries and stored procedures for use by other team members.
Develop a process to identify revenue-enhancing opportunities.
Work on special projects as assigned.