PACE Senior Revenue Cycle Analyst

Valir Health•Oklahoma City, OK

1d•Hybrid

About The Position

The Senior Revenue Cycle Analyst is responsible for end-to-end operational performance of the revenue cycle, including: PACE capitation (Medicaid / Medicare) validation and reconciliation, Claims and encounter submission (RAPS, EDS, EDI), Billing, collections, and participant liability, Accounts receivable and denial management, Insurance claims adjudication awareness (payor logic), Eligibility, enrollment, and revenue alignment, Financial reporting, controls, and audit readiness. This role blends provider-side execution with payer-side intelligence—a critical capability in PACE and value-based care environments. You will partner across Finance, Clinical, Enrollment, Compliance, and Operations to drive cash, eliminate leakage, and build scalable infrastructure.

Requirements

Bachelor’s degree required
7–10+ years healthcare revenue cycle experience
Experience across both: Claims billing (provider side)
Claims adjudication or payer logic (strongly preferred)
Strong knowledge of: ICD-10, CPT, HCPCS
EDI / clearinghouse workflows
Medicare / Medicaid reimbursement
Experience with capitation, risk models, or PACE strongly preferred
Proven ability to improve KPIs and operational performance
Keyboarding/dexterity: frequently; activity exists up to 75% of the time
Communication: ability to read, speak, and hear in English.
Strength: sedentary position (exerting up to 10 lbs of force occasionally)
Standing/Walking: Occasionally; activity exists up to 25% of the time
Demonstrate knowledge of specific and individual role in the fire/safety program including the following management plans: safety, security, hazardous materials/waste, emergency preparedness, life safety, medical equipment and utility systems.
Participate in the policies and procedures relating to infection control for self, patients and participants, and staff.
Observe proper body mechanics and safety precautions in all job duties.
Communicate information about incidents involving self, patients and participants, staff and/or visitors to appropriate parties, using facility incident reporting systems as appropriate.
Demonstrates the safe operation of equipment and machinery and follows procedures for reporting and correcting an unsafe situation.
Attend and participate in all applicable training and development workshops including mandatory annual in-services/competencies.
Actively identify and participate in training, education and developmental activities to improve own knowledge and performance or the knowledge and performance of others.
Seek and use feedback to improve own performance.
Support Valir Health’s culture of learning by sharing insights, tools, and best practices with colleagues across departments.

Nice To Haves

Master’s preferred
Claims adjudication or payer logic (strongly preferred)
Experience with capitation, risk models, or PACE strongly preferred

Responsibilities

Own daily execution of revenue cycle operations across claims, billing, collections, and reconciliation.
Improve net collections, reduce avoidable write-offs, and accelerate cash conversion.
Ensure complete and accurate revenue capture across all service lines and payment models.
Monitor end-to-end revenue flow—from enrollment to payment realization.
Validate monthly Medicaid and Medicare capitation payments.
Reconcile eligibility, enrollment, and payment rosters.
Manage retroactive adjustments, disenrollments, and payment corrections.
Ensure alignment between participant status, encounter data, and financial reporting.
Oversee submission and performance of claims, encounters, RAPS, EDS, and clearinghouse transactions.
Apply strong understanding of payer adjudication logic to improve acceptance and payment rates.
Monitor rejection trends and implement rapid corrective actions.
Ensure compliance with CMS and state-specific submission requirements.
Lead AR strategy across all payer types and participant liability.
Reduce denial rates through root-cause analysis and upstream fixes.
Improve Days in AR, underpayment recovery, and appeals success rates.
Establish disciplined follow-up and escalation workflows.
Maintain working knowledge across reimbursement methodologies: IPPS / OPPS / PDPM / LTACH / SNF / physician / outpatient / ancillary.
Understand coding frameworks (ICD-10, CPT, HCPCS) and their financial implications.
Connect clinical activity and utilization patterns to revenue outcomes and expense trends.
Analyze trends in claims expense, utilization, and cost drivers.
Partner with clinical and operations teams to identify inefficiencies and cost leakage.
Translate utilization insights into actionable operational improvements.
Build and maintain KPI dashboards (AR, denials, cash, encounter acceptance, capitation accuracy).
Support month-end close, accruals, and financial reconciliation.
Ensure audit-ready documentation for CMS, state, and internal reviews.
Strengthen internal controls across all revenue workflows.
Optimize EHR, billing systems, clearinghouses, and reporting tools.
Improve workflow integration across departments.
Drive automation and scalability for multi-state growth.