Revenue Cycle Analyst II

Amerihealth Caritas•,

6d•Remote

About The Position

The Revenue Cycle Analyst II is responsible for supporting the End-to-End (E2E) Premium Revenue Cycle, ensuring revenue is accurate, complete, timely, and compliant from enrollment through payment, reconciliation, reporting, and resolution. This role is responsible for working with dialysis and medical facilities to complete CMS-2728 ESRD forms. This role also ensures data integrity across upstream and downstream systems by monitoring, investigating, and resolving discrepancies, while recommending corrective actions to support accurate financial reporting and operational performance. The analyst partners with cross-functional teams to resolve issues that impact financial results and supports enterprise oversight, governance, and reporting needs by validating data across multiple sources, contributing to process improvements that strengthen revenue controls and transparency across the full premium revenue lifecycle, and using technical tools such as, SQL, and Databricks.

Requirements

Bachelor’s Degree.
Minimum 4 years of experience.
Intermediate working knowledge of business computer programs, applications and systems, database structures and data files required.
Intermediate understanding of Managed Care practices and policies, such as but not limited to; Back-end Business practices, Claims Processing/Clinical Coding, Billing, and Payments.
Strong analytical skills and Medicaid/Medicare revenue cycles is a must.
Ability to identify issues, research, investigate, and document findings.
Strong communication (both written and verbal), analytical and problem-solving skills.
Strong organizational skills with the ability to coordinate several projects simultaneously.
SQL
Databricks

Nice To Haves

3 years experience in healthcare, finance and/or financial reporting, preferred.

Responsibilities

Analyze and interpret financial and membership data across the End-to-End (E2E) Premium Revenue Cycle from sources including 834 enrollment files, 820/835/member payment files, Lock-in files, Jiva, the Data Warehouse, Data Lake, and the Facets system to identify discrepancies, determine root causes, and recommend corrective actions.
Prepare and maintain discrepancy reports, state reports, and other plan-specific financial reports to identify, reconcile, and control variances.
Develop, maintain, and enhance databases, queries, joins, tables, and forms; create SQL queries, stored procedures, user-defined functions, and related functional and technical documentation; and demonstrate proficiency in Databricks to support data extraction, transformation, analysis, and reporting.
Generate and update monthly reconciliation reports, audit support materials, and other required reporting; review results for material differences and escalate issues to management when appropriate.
Maintain working knowledge of 834, 820, 835, and 837 companion guides, system notices, and member documentation; advise management on actions needed to meet state and business requirements.
Provide training, guidance, and ongoing operational support across lines of business and products, ensuring consistent understanding and execution of Revenue Cycle Management processes, systems, and requirements.
Meet monthly and quarterly deadlines while providing support to Accounting, EDI, Enrollment, Encounters, Statutory, Actuarial, and other business partners.
Attend and lead departmental and cross-functional meetings to facilitate collaboration, communicate key updates, drive issue resolution, and ensure alignment on priorities, decisions, and action items.
Provide backup support for the Lead Analyst by assisting with priority assignments, operational oversight, issue escalation, reporting, and coordination of departmental activities to ensure continuity of essential functions.
Contribute to annual departmental goals and respond to stakeholder requests for analysis and information within established timeframes.
Support innovation initiatives aligned with enterprise governance by identifying process gaps, control weaknesses, and opportunities for automation.
Strong analytical skills to identify financial trends and anomalies.
Partner with internal departments to ensure compliance with contractual requirements.
Participate in testing and design requirements and performs testing of new releases for internal applications.
Balance multiple competing priorities while meeting critical deadlines.
Independent work capability combined with collaborative mindset.
Perform other duties as assigned.