Revenue Cycle Analyst (Medical)

Sharon Werdebaugh
Job Description
AlignHR Talent is redefining how the search for quality talent is conducted and takes you beyond basic recruitment services. Our job is to bring a new approach to your search needs. We identify talent  that aligns with your business goals, objectives, and core values.

We are assisting our client in Bridgeport, WV to find a Revenue Cycle Analyst:

Principal Duties and Responsibilities

  • Reviews reimbursements and variance reports to identify and trend payment discrepancies (e.g., denials, underpayments, etc.), reporting results to leadership on a regular basis
  • Conducts ongoing analysis of contract compliance and financial performance for third-party payers to provide leadership with support during payer contract negotiations
  • Interprets compiled dashboard data and develops regular reimbursement reports to explain trends and identify root causes of financial performance for the organization’s financial leaders
  • Analyzes dashboard data to identify potential gaps in the department’s reimbursement process flows
  • Helps design and implement improvements to established or proposed reimbursement process flows in an effort to maximize potential revenue
  • Implements Chronic Care Management plans
  • Ensure that the proper transition of care codes are used
  • Identifies potential sources of revenue leakage and assists in developing data-driven initiatives to resolve any issues
  • Understands and is articulate in communicating the processes and documentation requirements for accurate and compliant charge capture
  • Knowledge of ICD-10, HEDIS scores, and Humana reimbursement rates
  • Does on-going monitoring and auditing of areas assigned to ensure appropriate charging, etc
  • Ability to provide valuable input for revenue cycle process improvement initiatives

Position Qualifications Education

  • Bachelor’s degree in business, accounting, healthcare administration, or finance required 
  • At least 2-3 years of experience in healthcare accounting or finance required
  • Experience must be with doctor's offices and/or clinics, not just hospitals

Knowledge, Skills, Abilities

  • Knowledge of third-party payer regulations, reimbursement, and payment policies
  • Understanding of billing practices and operational workflows
  • Understanding of medical terminology and medical record coding
  • Proven analytic and problem-solving skills
  • Strong interpersonal skills and the ability to work collaboratively
  • Proficiency in utilizing Microsoft Excel and other database management software
  • Ability to extract and analyze relevant data
  • Chronic care management plans
  • Transition of care codes
  • Humana reimbursement rates by facility type
  • HEDIS scores
Contact Information

Citynet First Energy WBOY-TV12 United Hospital Center Stephanie Hayhurst-Hall State Farm Agency Chase Huntington Bank Salem International University The Thrasher Group, Inc. HomeFinders Plus Real Estate Steptoe & Johnson PLLC Dominion MVB Bank, Inc. Arnett Carbis Toothman PLLC Antero Resources Corporation