Revenue Cycle Analyst

UCSF•San Francisco, CA

About The Position

The Adult Pulmonary Function Laboratory, administratively housed within the Cardiovascular Research Institute (CVRI), performs diagnostic testing for patients with a wide range of pulmonary diseases. These services support clinical research and provide training for medical professionals. The Revenue Cycle Analyst will function independently, possessing a comprehensive understanding of all revenue cycle components. This role involves leading and completing complex projects, analyzing and resolving intricate billing and reimbursement issues such as claim corrections, charge routing discrepancies, and system configuration errors. Expertise in payer contracts and coordination of benefits will be applied to address billing issues, mitigate reimbursement risk, and ensure accurate, compliant claim submission. The analyst will evaluate trends in denials, accounts receivable, and reimbursement outcomes to prioritize workflows and drive improvements, recommending and implementing process, system, and policy enhancements. Collaboration with clinical, revenue cycle, compliance, and financial services teams is essential for designing, implementing, and sustaining compliant billing workflows and system solutions. Establishing escalation pathways and alternative reimbursement strategies for complex claims and funding scenarios, ensuring alignment with internal policies and external regulatory requirements, is also a key responsibility.

Requirements

Comprehensive understanding of all components of the revenue cycle.
Expertise in payer contracts and coordination of benefits.
Ability to analyze and resolve highly complex billing and reimbursement issues.
Experience in evaluating trends in denials, accounts receivable, and reimbursement outcomes.
Skills in recommending and implementing process, system, and policy enhancements.
Ability to collaborate with clinical, revenue cycle, compliance, and financial services teams.
Experience in establishing escalation pathways and alternative reimbursement strategies.

Responsibilities

Leads and completes complex projects of diverse scope.
Analyzes and resolves highly complex billing and reimbursement issues, including claim corrections, charge routing discrepancies, and system configuration errors.
Applies expertise in payer contracts and coordination of benefits to address billing issues, mitigate reimbursement risk, and ensure accurate, compliant claim submission.
Evaluates trends in denials, accounts receivable, and reimbursement outcomes to prioritize workflows and drive improvements.
Recommends and implements process, system, and policy enhancements to support efficient service delivery and optimize reimbursement.
Collaborates with clinical, revenue cycle, compliance, and financial services teams to design, implement, and sustain compliant billing workflows and system solutions.
Establishes escalation pathways and alternative reimbursement strategies for complex claims and funding scenarios, ensuring alignment with internal policies and external regulatory requirements.