Revenue Cycle Analyst

Momentum for Health • San Jose, CA

5h • $75,000 - $95,000 • Onsite

About The Position

The Revenue Cycle Analyst is responsible for the full lifecycle management of Momentum’s reimbursement activities, including billing, denial management, accounts receivable follow-up, payment reconciliation, reimbursement analysis, and collections. This position will be a subject matter expert in behavioral health billing regulations, Santa Clara County behavioral health reimbursement requirements, Medi-Cal claim methodologies, managed care billing, and electronic health record systems, such as my Avatar. Working independently, the Revenue Cycle Analyst proactively identifies revenue cycle issues, researches root causes, develops corrective actions, and collaborates with clinical, program leads, program administrators, finance, quality, and operational teams to maximize reimbursement and ensure regulatory compliance. This role functions as a high-level individual contributor with ownership of assigned revenue cycle processes from issue identification through final resolution.

Requirements

• BS Degree in Accounting, Finance, Business Administration, Health Information Management, Healthcare Administration, or related field; OR equivalent combination of education and relevant healthcare revenue cycle experience
• Minimum 3-5 years of healthcare billing, reimbursement, revenue cycle, or accounts receivable experience
• Experience independently resolving claim denials, payment variances, and aging accounts receivable
• A valid California driver’s license, current automobile insurance, and a good driving record, as documented by a DMV report.
• Hearing and talking on telephone and in person; standing, walking, sitting, pinching and finger flexion are required constantly (over 2/3 of the workday); Lifting, carrying, pushing, pulling, bending, stooping, crouching, kneeling and twisting are required occasionally (under 1/3 of the workday); Balancing, climbing and crawling are generally not required.
• Advanced understanding of Revenue Cycle Management
• Advanced understanding of Healthcare Accounts Receivable
• Advanced understanding of Denial Management
• Advanced understanding of Behavioral Health Billing
• Advanced understanding of Medi-Cal Billing Requirements
• Advanced understanding of Payment Posting
• Advanced understanding of Managed Care Reimbursement
• Advanced understanding of Financial Reconciliation
• Advanced understanding of Revenue Integrity Principles
• Strong root-cause analysis and problem-solving abilities
• Ability to independently research and resolve complex reimbursement issues
• Ability to identify trends and recommend operational improvements
• Strong quantitative and accounting skills
• Advanced Microsoft Excel skills, including Pivot Tables, VLOOKUP/XLOOKUP, and Financial analysis functions
• Experience with Claims clearinghouses (ChangeHealthcare/Inovolan)
• Experience with revenue cycle processes
• Experience with financial reports creation and analysis
• Ability to effectively communicate reimbursement and financial concepts to both operational and clinical staff
• Strong written and verbal communication skills
• Ability to influence process improvements across departments
• Revenue Cycle Expertise
• Accountability
• Critical Thinking
• Financial Acumen
• Problem Solving
• Data Analysis
• Attention to Detail
• Customer Service
• Regulatory Compliance
• Process Improvement
• Initiative
• Independent Judgment
• Collaboration

Nice To Haves

• Experience billing Santa Clara County Behavioral Health programs
• Experience with Specialty Mental Health Services (SMHS)
• Experience with Medi-Cal, Medicare, and Managed Care reimbursement
• Experience using myAvatar EHR
• Experience interpreting payer contracts and reimbursement processes
• Experience performing payment reconciliation and revenue analysis
• Experience with behavioral health, mental health, substance use disorder, or community healthcare services

Responsibilities

• Manage behavioral health billing and reimbursement processes from claim generation through payment collection
• Analyze and resolve complex billing issues, claim edits, denials, underpayments, and rejected claims
• Research reimbursement discrepancies and implement corrective actions to prevent recurring issues
• Monitor claim submission activity and ensure timely filing compliance
• Conduct comprehensive accounts receivable analysis and prioritize collection activities
• Follow claims from point of service through final payment resolution
• Independently investigate and resolve denied or rejected claims
• Identify root causes of denial trends and develop corrective action plans
• Prepare and submit appeals and supporting documentation
• Track appeal outcomes and recovery performance
• Partner with clinical, quality, and program staff to reduce future denials
• Create, review, and post payments, adjustments, transfers, and contractual allowances
• Validate reimbursement accuracy based on payer contracts and county funding requirements
• Analyze revenue trends and billing patterns
• Conduct bi-weekly accounts receivable analytics and aging reviews
• Prepare financial and operational reports with recommendations for leadership
• Maintain expertise in Medi-Cal Specialty Mental Health Services, Santa Clara County Behavioral Health Services requirements, CalAIM initiatives, Behavioral health documentation requirements, Managed Care billing guidelines, and Federal and State reimbursement regulations
• Interpret county claiming requirements and communicate operational impacts to leadership and program teams
• Collaborate with county representatives and commercial payers to resolve reimbursement issues
• Serve as a subject matter expert for revenue cycle processes within myAvatar EHR, Inovalon, and Other behavioral health EHR platforms
• Identify workflow gaps impacting reimbursement
• Participate in system implementation, testing, upgrades, and optimization projects
• Develop recommendations to improve billing efficiency and revenue capture
• Conduct audits of clinical documentation and billing data to ensure claim accuracy
• Identify compliance risks related to billing and reimbursement activities
• Partner with clinical and quality teams to improve documentation supporting medical necessity and billing requirements
• Ensure compliance with federal, state, county, payer, and agency regulations
• Act as a billing and reimbursement resource for program managers, leadership, clinicians, and finance staff
• Train staff on reimbursement requirements, documentation standards, and billing workflows
• Participate in process improvement initiatives designed to increase cash collections and reduce denials
• Lead revenue cycle projects and special assignments as directed

Benefits

• Medical benefits –Kaiser--ranging from $0 Deductible Plan with $15 Copay to $,3400 Deductible Plan with Health Savings Account. Sutter Health plans are also available from $0 Deductible Plan to $2,500 Deductible Plan.
• Dental benefits –Guardian: 1 dental HMO and 2 PPOs
• Vision benefits – 2 options from Guardian VSP: a standard vision plan and an enhanced vision plan
• Defined contribution amount of up to $15,433.08 per year (prorated for part-time employees working less than 40 hours per week) to purchase benefits of choice on a cafeteria plan basis.
• Retirement plan with a generous employer match starting at 4% after one year of employment.
• Vacation time accruing up to 25 days per year
• 6 days of sick time per year
• 12 paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree