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Revenue Cycle Business Systems Analyst
Revenue Cycle Business Systems Analyst
Reports To Director of Business Systems
Position Summary
The Revenue Cycle Business Systems Analyst is a key member of the Central Billing Office (CBO), supporting the revenue cycle operations of a multi-site ambulatory surgery center (ASC) management portfolio. This role is responsible for analyzing, configuring, and optimizing the systems and workflows that drive consistent, scalable billing performance across all managed surgery center locations. Serving as the operational and technical bridge between CBO billing staff, facility-level teams, and IT/vendor partners, this analyst ensures that technology solutions support accurate charge capture, timely claims submission, and maximum reimbursement across the enterprise.
Key Responsibilities
- Support and optimize CBO revenue cycle workflows across the full billing lifecycle, including surgical scheduling interfaces, charge capture, facility fee billing, claims submission, payment posting, denial management, and AR follow-up, for multiple ASC locations.
- Serve as a system subject matter expert for CBO staff and facility-level billing contacts, providing guidance on platform usage, workflow standards, and billing best practices.
- Gather and translate business requirements from CBO leadership and facility stakeholders into functional specifications for system enhancements, workflow improvements, or new implementations.
- Configure, test, and support revenue cycle platforms used across the managed portfolio, including ASC practice management systems, clearinghouses, and reporting/analytics solutions.
- Assist in the onboarding of new ASC locations into CBO systems and workflows, including data migration support, system setup, and staff training.
- Manage and maintain the charge description master (CDM) across facilities, ensuring consistent and accurate mapping of surgical procedures, implants, and supply charges to appropriate CPT/HCPCS codes and revenue codes.
- Support multi-payer enrollment, fee schedule build and maintenance, and EDI transaction management (837I, 835, 270/271, 278) across all managed facilities.
- Identify and resolve systemic claim edit, rejection, and denial trends that span multiple locations; escalate payer-specific issues and coordinate with CBO billing teams on remediation.
- Support system upgrades, payer requirement changes, and regression testing with minimal disruption to CBO and facility operations.
- Maintain thorough documentation including workflow diagrams, CDM change logs, system configuration records, user guides, and training materials.
- Assist in the evaluation and implementation of new revenue cycle technologies and vendor solutions relevant to CBO and ASC operations.
- Support the creation and submission of routine state regulatory reports, ensuring accuracy, completeness, and adherence to applicable submission deadlines.
- Ensure system configurations and billing workflows comply with CMS Ambulatory Payment Classification (APC) guidelines, ASC-covered procedures requirements, payer contracts, and applicable state and federal regulations.
- Perform other duties as assigned.
Required Qualifications
- Bachelor's degree in Health Information Management, Business Administration, Information Systems, or a related field; or equivalent work experience.
- 3+ years of experience in healthcare revenue cycle or healthcare IT, with at least 1–2 years in an ASC, outpatient surgical, or facility billing environment.
- Working knowledge of ASC facility billing, revenue codes, UB-04 claim form, and outpatient coding guidelines.
- Familiarity with EDI transaction sets, clearinghouse operations, and payer enrollment processes.
- Proficiency in reporting tools; ability to query and interpret data across multiple facilities (SQL experience a plus).
- Strong analytical and problem-solving skills with the ability to identify trends across a multi-site portfolio.
- Strong organizational skills with the ability to manage multiple priorities and projects across a multi-site environment.
- Hands-on experience with system configuration or implementation support in a healthcare revenue cycle or healthcare IT context.
- Excellent communication skills; able to work effectively with CBO leadership, facility administrators, and vendor partners.
Preferred Qualifications
- Experience working in a centralized billing or shared services environment supporting multiple locations.
- Experience with ASC-specific platforms (e.g., HST Pathways, Amkai, Waystar, or similar).
- Familiarity with prior authorization platforms and payer portals for high-volume surgical specialties.
- Experience managing or auditing a CDM across multiple facilities or business units.
- Knowledge of CMS ASC-covered procedures, APC grouping logic, and Medicare outpatient billing rules.
- Experience with state regulatory reporting requirements applicable to ASCs, including licensure, cost reporting, or payer-mandated data submissions.
- Experience with file transfer automation and scripting (e.g., SFTP workflows, scheduled batch jobs, or scripting in Python, PowerShell, or similar) to support EDI, reporting, or system integration tasks.
- Experience with HL7 interface management, including troubleshooting inbound/outbound message flows between clinical and billing systems.
- Familiarity with AI-driven RCM platforms, solutions, and AI-assisted coding.
- CRCR, CPC-H, RHIT, or equivalent certification preferred.
Work Environment
- Hybrid / Remote
- Occasional travel to corporate office or managed surgery center locations may be required.
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