REVENUE CYCLE ANALYST II

C2Q Health Solutions•New York, NY

8d•$80,000 - $90,000•Onsite

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. This position independently manages day-to-day revenue cycle operations, reporting on revenue cycle functions, and provides guidance to Revenue Cycle Analyst I staff.

Requirements

Bachelor's degree required.
3-5 years of healthcare experience, managed care setting is required.
Proficiency in data analytics, i.e. SAS, SQL is required.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is required.
Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS.
Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.
Effective oral, written, and interpersonal communication skills are required.
Able to multitask efficiently, effectively, and timely.
Strong organizational skills and work ethic.
Detail-oriented, professional and collaborative, a great team player.

Nice To Haves

Certified Professional Coder a plus.
Claims adjudication and understanding of claims PPS is 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 A/R.
Perform full analytics on all revenue operations for all Line of Business of Centerlight.
Perform analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
Independently investigate and resolve Enrollment/Intake discrepancies for correction/rebilling.
Coordinate with Enrollment on PDE rejections and assist the Enrollment team 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 GL entries related to revenue.
Assist Actuarial with data analytics as needed.
Develop and maintain financial reporting and analytics in Tableau/Power BI (including KPI dashboards) used by senior leadership to track actual results vs. target.
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 (SOPs).
Create SQL queries/ store procedures for use by other members of the team.
Work of developing process to identify revenue enhancing opportunities.
Work on special projects as assigned.