revenue cycle manager

Diglip

We are seeking a highly experienced Laboratory Billing Specialist / RCM Manager to oversee and optimize all aspects of our diagnostic laboratory billing operations. This role will act as the internal billing authority, working closely with our third-party billing company to ensure clean claim submission, minimize denials, and maximize reimbursement.The ideal candidate must have deep expertise in clinical laboratory billing, coding, payer guidelines, and denial management, and should be capable of identifying gaps, resolving issues, and implementing process improvements.Key Responsibilities<ul><li>Oversee and audit the performance of the external billing company</li><li>Review and ensure clean claim submission (first-pass resolution)</li><li>Analyze and resolve denials (CO-45, CO-97, CO-16, PR-96, etc.)</li><li>Identify root causes of denials and implement corrective workflows</li><li>Monitor AR (Accounts Receivable) and aging reports</li><li>Ensure proper usage of CPT codes, ICD-10 codes, modifiers (e.g., 59, 91, 25)</li><li>Validate medical necessity compliance (LCD/NCD guidelines)</li><li>Manage payer-specific requirements (Medicare, Medicaid, BCBS, Aetna, UHC, etc.)</li><li>Work on eligibility verification and benefits investigation</li><li>Review EOBs/ERAs and payment posting accuracy</li><li>Ensure proper credentialing and enrollment (NPI, CLIA, PECOS, CAQH)</li><li>Maintain compliance with HIPAA and CMS billing regulations</li><li>Coordinate with lab operations for proper test coding &amp; panel setup</li><li>Optimize workflows for high-volume tests (CBC, CMP, Ferritin, Toxicology, etc.)</li><li>Track rejection trends and clearinghouse errors</li><li>Generate weekly/monthly billing performance reports</li><li>Implement strategies to reduce write-offs and maximize collections</li></ul>Required Skills &amp; ExpertiseCore Billing Knowledge<ul><li>Strong understanding of Laboratory Billing (Clinical &amp; Toxicology preferred)</li><li>Expertise in:</li><li>CPT / HCPCS coding</li><li>ICD-10 diagnosis coding</li><li>Modifiers usage</li><li>Medical necessity rules</li><li>Hands-on experience with:</li><li>Denial Management &amp; Appeals</li><li>AR Follow-ups</li><li>Insurance Verification</li><li>Charge Entry &amp; Payment Posting</li></ul>Technical &amp; System Skills<ul><li>Experience with LIS (Laboratory Information Systems) and billing software</li><li>Familiarity with Clearinghouses (Office Ally, Change Healthcare, etc.)</li><li>Knowledge of EDI transactions (837, 835, 270/271)</li><li>Ability to audit data between LIS and Billing Systems</li><li>Strong Excel / Google Sheets skills for reporting &amp; analytics</li></ul>Payer &amp; Compliance Knowledge<ul><li>Experience handling:</li><li>Medicare / Medicaid billing</li><li>Commercial insurance (BCBS, Aetna, UHC, Cigna, etc.)</li><li>Understanding of:</li><li>LCD/NCD policies</li><li>Frequency limitations</li><li>Bundling &amp; unbundling rules</li><li>Familiarity with CLIA regulations for lab billing</li></ul>Credentialing &amp; Enrollment<ul><li>Experience with:</li><li>Provider Enrollment (PECOS, CAQH)</li><li>NPI registration and maintenance</li><li>CLIA certification handling</li><li>Ability to ensure lab is properly enrolled with all payers</li></ul>Preferred Qualifications<ul><li>Experience working with high-complexity labs or toxicology labs</li><li>Prior experience managing or auditing outsourced billing teams</li><li>Knowledge of HL7 integrations and lab-machine workflows</li><li>Certification such as:</li><li>CPB (Certified Professional Biller)</li><li>CPMA / CPC (AAPC)</li></ul>Key Performance Indicators (KPIs)<ul><li>Reduction in denial rate (%)</li><li>Increase in clean claim rate</li><li>Improvement in AR days</li><li>Recovery of underpaid / denied claims</li><li>Accuracy in coding and billing compliance</li></ul>Note: Candidates without hands-on lab billing experience will not be considered.Job Type: Full-timePay: Rs150,000.00 - Rs200,000.00 per monthApplication Question(s):<ul><li>How many years of US laboratory billing experience do you have?</li><li>Have you worked with denial codes like CO-45, CO-97, CO-16, PR-96?</li><li>Are you comfortable working onsite and night shifts (US hours)?</li></ul>Work Location: In person

Laboratory Billing Specialist / Revenue Cycle Manager (RCM)

Specialty Dental Brands

<div>Description:

Specialty Dental Brands (SDB) is a leading dental service organization focused on partnering with the best doctors with a proven record of accomplishment of patient care and community involvement. We provide proven operational support, technology, and overall practice management across a nation-wide network of leading class pediatric dentistry, orthodontics, and oral surgery platforms. We are looking for a talented and highly motivated individual who has a natural desire to improve and build new processes and thrive in a start-up culture and rapidly growing business.
Manager, Revenue Cycle Management are primarily responsible for supporting RCM functions of the front and back office through training, education, analyzing collections, resolving non-payables special projects, handling inquiries for complex revenue cycle issues, front office auditing, clearing house management, and assistance on any special projects assigned.
Job Type:<ul><li>
Full-Time</li><li>
Hybrid (after onboarding period)</li><li>
May require up to 50-75% Travel depending on the need of the practice or region.</li><li>
Based in the region you will directly support.</li></ul>
Responsibilities:<ul><li>
RCM Manager will be responsible for the team in which they work with. Organizing the support of the RCM Specialists that report to them and the regions they support.</li><li>
RCM Manager will be responsible for assigning projects to the RCM Specialists that report to them.</li><li>
RCM Manager will be responsible for the assigned region's net revenue percentage to ensure the practices increase revenue and decrease RCM errors.</li><li>
RCM processes, policies, and compliance items are followed by working with the Regional Directors and RCM Director.</li><li>
SME for the Revenue Cycle process and communicate, educate, and train front and back-office RCM processes.</li><li>
SME knowledge of billing, coding, and productivity auditing</li><li>
SME knowledge of payer processing and payer policies, Medicaid, and Dental Payers, sometimes medical payers.</li><li>
Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.</li><li>
Must have excellent organizational skills and ability to prioritize and coordinate workload with high proficiency and accuracy.</li><li>
Must have excellent analytical and problem-solving skills.</li><li>
Maintains strict confidentiality of patient&rsquo;s medical records and adherence to all HIPAA and ACHC policies and regulations.</li><li>
Must be extremely accurate with attention to details, policies, and procedures.</li><li>
SME knowledge of billing, coding, and productivity auditing</li><li>
Ability to report trending data and identify areas of RCM opportunities.</li><li>
Must develop and update multiple Action Plans and produce positive revenue outcomes.</li><li>
Must be agile to move from project to project at a quick pass or be able to change gears quickly.</li><li>
Meet established production and quality standards as set by Specialty Dental Brands</li><li>
Excellent and accurate calculator and computer skills. Including the ability to use Microsoft Excel, Microsoft Word, E-Mail. Excel and Data will be a major function of the job; therefore, you must be able to work with Excel functions and pivot tables.</li><li>
Performs special projects and other duties as assigned.</li><li>
Immediate to High-level knowledge of medical and dental billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding EOBs.</li><li>
Strong oral, written, and interpersonal communication skills</li><li>
Strong time management and organizational skills</li><li>
Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills</li><li>
Ability to read, understand, and apply state/federal laws, regulations, and policies.</li><li>
Ability to adapt to and train on multiple PM systems.</li><li>
Ability to communicate with diverse personalities discreetly, maturely, and professionally.</li><li>
Ability to remain flexible and work within a collaborative and fast-paced environment.</li><li>
Ability to work easily and cooperatively with other departments.</li><li>
Ability to work independently and follow through on tasks without direct supervision.</li><li>
Ability to work well under pressure in a flexible, diplomatic, and expeditious manner.</li><li>
Ability to work with all levels of teams, Entry-level to Sr. Leadership</li></ul>
Organizational Alignment:<ul><li>
Reports to: RCM Director</li><li>
Other Key Relationships: General Manager, VP of Revenue Cycle, RD for region providing suppor</li></ul>
Requirements:
<ul><li>High School Diploma or GED</li><li>
At least five (5) years in the healthcare or dental RCM functions.</li><li>
At least five (5) years in billing and claims resolution</li><li>
At least five (5) years of dental front office RCM functions</li><li>
Preferred: CPB (Certified Professional Biller), CMB (Certified Medical Biller), CDC (Certified Dental Coder), CDBS (Certified Dental Billing Specialist). Must be willing to obtain certification if asked.</li></ul></div>

Manager, Revenue Cycle Management

Urology Centers of Alabama

<div>General Summary
The Director of Revenue Cycle Management (RCM) provides enterprise-level leadership and strategic direction for all revenue cycle operations at Urology Centers of Alabama (UCA). This position is accountable for the performance, integrity, and continuous improvement of the full revenue cycle&mdash;from charge capture and coding through billing, collections, and reimbursement&mdash;ensuring alignment with organizational financial goals, regulatory requirements, and best practices in healthcare revenue operations.
Unlike a managerial role focused primarily on daily workflows, the Director establishes revenue cycle strategy, performance standards, monthly reporting, and long-term optimization initiatives across all UCA entities and service lines. The Director partners closely with executive leadership, physicians, clinical operations, compliance, IT, and finance to drive sustainable revenue growth, mitigate compliance risk, and enhance operational efficiency.
Key responsibilities include oversight of the entire revenue cycle process including: front desk collections, prior authorization, benefits verification, coding accuracy, denial management, payment posting, payer contract performance, reimbursement optimization, and EMR revenue integrity auditing. The Director develops and monitors key performance indicators (KPIs), leads system and process transformation initiatives, and provides executive-level reporting and analysis to the CFO and senior leadership team.
Essential Functions
Strategic Revenue Cycle Leadership
1. Provide enterprise-level strategic leadership and oversight for all revenue cycle operations at Urology Centers of Alabama, P.C., including registration, charge capture, coding, billing, claims submission, payment posting, denials management, and collections.
2. Develop and execute revenue cycle strategies to maximize reimbursement, reduce revenue leakage, and improve cash flow
3. Establish, monitor, and report key performance indicators (KPIs) such as days in A/R, clean claim rate, denial rate, net collection rate, and reimbursement variance
EMR &amp; Documentation Auditing
4. Lead ongoing audits of the EMR to ensure clinical documentation supports billed services, medical necessity, and compliance with payer and regulatory requirements
5. Partner with physicians and clinical leadership to address documentation gaps, coding accuracy, and workflow inefficiencies identified through EMR audits
6. Oversee pre- and post-billing audits to validate charge capture accuracy for urology-specific services, including office visits, procedures, diagnostics, surgeries, and ancillary services
7. Ensure EMR templates, order sets, and workflows support compliant, efficient, and standardized revenue cycle processes across all locations
Reimbursement &amp; Compliance Oversight
8. Audit reimbursements to ensure payments align with payer contracts, fee schedules, and applicable regulations
9. Identify underpayments and overpayments and lead recovery, appeal, and refund processes as required
10. Monitor payer trends, reimbursement changes, and regulatory updates impacting urology services
11. Collaborate with Compliance and Legal teams to mitigate financial and regulatory risk related to coding, billing, and reimbursement practices
Denials Management &amp; Financial Performance
12. Oversee denial prevention and appeals strategies, including root-cause analysis and implementation of corrective action plans
13. Analyze denial trends and implement system, documentation, and workflow improvements to reduce recurrence
14. Ensure timely follow-up and resolution of denied, delayed, or unpaid claims
Leadership &amp; Collaboration
15. Lead, mentor, and develop revenue cycle leadership and staff, fostering accountability, compliance, and continuous improvement
16. Collaborate with physicians, clinical teams, IT, and Finance to align documentation, coding, and billing practices
17. Serve as a trusted advisor to executive leadership at Urology Centers of Alabama, P.C. on revenue integrity, reimbursement risk, and performance improvement opportunities
Reporting &amp; Analytics
18. Prepare and present comprehensive revenue cycle performance and audit reports to executive leadership
19. Provide actionable insights related to reimbursement variances, audit findings, and revenue optimization opportunities
20. Support budgeting, forecasting, and strategic planning initiatives related to revenue cycle operations
Supervisory Requirements
This position will supervise the RCM Managers and subordinate staff.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit, handle, or feel objects, tools, or controls; reach with hands and arms; stoop, kneel, crouch, or crawl; and talk or hear. The employee must occasionally lift and/or move more than 45 pounds.
Minimum Qualifications
1. 7&ndash;10 years of progressive healthcare revenue cycle experience in a large-scale corporation (&gt;$100M) and has oversight of multiple ancillary revenue streams.
2. Minimum of 5&ndash;10 years in a leadership role.
3. Demonstrated expertise in revenue cycle performance metrics, including AR days, denial rates, net collection rate, cash acceleration, and reimbursement optimization.
4. Strong knowledge of payer contracts, reimbursement methodologies, and regulatory requirements (CMS, HIPAA, OIG, Medicare, Medicaid, and commercial payers).
5. Proven ability to lead enterprise-wide initiatives, drive process improvement, and implement system or workflow transformations.
6. Experience partnering with physicians, clinical leadership, finance, compliance, and IT in a complex healthcare organization.
7. High level of proficiency with electronic medical record (EMR) and practice management systems and related revenue cycle technology.
8. Excellent analytical, communication, and executive-level reporting skills.
9. Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.
Preferred Qualifications
Bachelor&rsquo;s or Master&rsquo;s degree in Healthcare Administration, Business, Finance, or related
Licensure, Certification, Registration Requirements
CPC, CCS, CPMA, or similar coding/compliance certification</div>

Revenue Cycle Management Director

La Rabida Children's Hospital

<div><div><div><h2 class="jobSectionHeader">Company Description</h2></div><div>
La Rabida Children&rsquo;s Hospital provides specialized, family-centered health care to children with medically complex conditions, disabilities, and chronic illness. Through expertise, compassion, and advocacy we help children and their families reach their fullest potential, regardless of their ability to pay.
Our not-for-profit hospital, licensed for 49 beds, helps transition children from neonatal or pediatric intensive care to home, by providing medical, rehabilitative and developmental care, and by training families to continue treatments and manage the necessary equipment in the home. La Rabida also provides extensive rehabilitation for those recovering from wounds or burns and treatment for exacerbations of chronic conditions.
The hospital&rsquo;s enhanced pediatric patient-centered medical home provides primary care to children with complex medical conditions and their siblings. Children with medical homes elsewhere come to La Rabida for specialty services. La Rabida offers a wide range of specialty services provided to children with sickle cell disease, diabetes, and many others. Children are supported in their emotional and developmental growth, particularly in cases where such growth has been interrupted by accident or disease.
Finally, La Rabida provides forensic and treatment services for children exposed to abuse and neglect, comprehensive assessments for wards of the state, early intervention for children between 0 and 3 years of age. Care coordination services for medically complex children are also provided for those who are covered by a health plan and receive care from providers in Cook County</div></div><div><div><h2 class="jobSectionHeader">
Job Description</h2></div><div>
Position Summary
The Revenue Cycle Manager is responsible for the strategic oversight and day-to-day management of the hospital&rsquo;s financial health. This role leads the Billing and Coding teams in a specialized pediatric environment, ensuring high-quality charge capture, accurate coding, and timely reimbursement.
A critical component of this role includes leading the department through a transition from legacy systems (Meditech and Athena) to an Epic platform, while maintaining expert compliance with Illinois Medicaid regulations and pediatric-specific billing requirements.
Key Responsibilities
Leadership &amp; Supervision<ul><li>Direct Supervision: Manage, mentor, and evaluate the performance of Billing and Coding specialists.</li><li>Staff Development: Provide continuous training on pediatric-specific coding (ICD-10-CM, CPT, HCPCS) and evolving payer regulations.</li><li>Workflow Optimization: Establish departmental KPIs (e.g., Days in AR, Clean Claim Rate, Denial Rate) and hold staff accountable to production standards.</li></ul>
Systems &amp; Implementation<ul><li>Legacy Management: Oversee current revenue operations within Meditech (Hospital/Inpatient) and Athena (Ambulatory/Outpatient) to ensure no revenue leakage during the transition.</li><li>Epic Implementation: Serve as the Revenue Cycle Subject Matter Expert (SME) for the Epic go-live. Duties include workflow design, system testing, data migration validation, and end-user training for the billing/coding modules.</li><li>Interoperability: Ensure seamless data flow between legacy archives and the new Epic environment.</li></ul>
Illinois Medicaid &amp; Pediatric Compliance<ul><li>Regulatory Expertise: Serve as the primary resource for Illinois Medicaid (HFS) guidelines, including Managed Care Organizations (MCOs) and the All Kids program.</li><li>Pediatric Billing: Manage complex pediatric billing scenarios, including neonatal care, rehabilitative therapy, and long-term pediatric chronic care.</li><li>Audit &amp; Compliance: Conduct internal audits to ensure coding accuracy and compliance with state and federal healthcare laws.</li></ul>
Financial Operations<ul><li>Denial Management: Analyze denial trends and implement root-cause solutions to reduce rejections from Illinois Medicaid and commercial payers.</li><li>Reporting: Prepare monthly financial reports and dashboards for senior leadership regarding AR aging and cash collection targets.</li><li>Liaison: Act as the bridge between clinical departments and the finance office to ensure clinical documentation supports billed services</li></ul></div></div><div><div><h2 class="jobSectionHeader">
Qualifications</h2></div><div>
Qualifications<ul><li>Education: Bachelor&rsquo;s degree in Healthcare Administration, Finance, or a related field (Master&rsquo;s preferred).</li><li>Experience: * Minimum 5+ years in Healthcare Revenue Cycle Management.</li></ul>
 o Proven experience in a supervisory role overseeing billing and coding professionals.
 o Direct experience with Illinois Medicaid reimbursement and policy.<ul><li>Technical Skills: * Proficiency in Meditech and AthenaIDX/One.</li></ul>
 o Epic Certification or previous experience leading an Epic Implementation (Resolute Hospital Billing/Professional Billing) is highly preferred.<ul><li>Certifications: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or CRCR (Certified Revenue Cycle Representative) preferred</li></ul> 
Required Competencies<ul><li> Change Management: Ability to lead a team through the technical and emotional challenges of a major EHR transition.</li><li>Analytical Thinking: Deep understanding of healthcare data to identify trends in underpayments or billing errors.</li><li>Pediatric Focus: Sensitivity to the unique billing needs of a small, 39-bed children&rsquo;s facility.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
Additional Information</h2></div><div>
La Rabida Children&rsquo;s Hospital is very proud to be an Equal Employment Opportunity Employer<div></div>
La Rabida is a place unlike any other. We understand the needs of families with children dealing with the most serious or complicated of conditions. With teams of the best healthcare providers in Chicago, we give continuous, comprehensive care, education, and support, helping families face their unique obstacles head-on.
La Rabida Children&rsquo;s Hospital is very proud to be an Equal Employment Opportunity Employer.</div></div></div>

Manager of Revenue Cycle

Reliant Healthcare Group

<div><ul><li>This is NOT a remote position</li></ul> 


Healthcare Billing &ndash; ABA Therapy | Pediatric Therapy | Private Duty Nursing (PDN) 


Location: Katy, TX

Job Type: Full-Time

Reports To: Revenue Cycle Manager 


Job Overview

We are seeking an experienced Senior Revenue Cycle Specialist (RCM) to support advanced billing and revenue cycle operations for ABA therapy, pediatric therapy (OT/PT/SLP), and Private Duty Nursing (PDN) services. This is a hands-on, non-supervisory role focused on complex claims, authorizations, denials, and assigned RCM projects. 


Key Responsibilities
<ul>
<li>Execute end-to-end revenue cycle management: eligibility, authorizations, billing, AR follow-up, and collections</li>
<li>Handle complex billing for ABA services, pediatric therapy, and PDN</li>
<li>Submit and track claims with Medicaid, Medicaid MCOs, and commercial insurance</li>
<li>Manage denials, appeals, underpayments, and payer escalations</li>
<li>Monitor authorized units, frequency, and payer compliance</li>
<li>Work assigned accounts receivable (AR) and aging buckets</li>
<li>Support billing audits, payer reviews, and documentation requests</li>
<li>Own assigned RCM projects (workflow optimization, payer setup, EMR clean-up)</li>
<li>Collaborate with intake, scheduling, and clinical teams</li>
<li>Provide reporting and insights to the RCM Manager</li></ul> 


Required Experience
<ul>
<li>4+ years in healthcare revenue cycle, medical billing, or AR</li>
<li>Direct experience with ABA billing, therapy billing, or PDN billing a plus</li>
<li>Strong knowledge of Medicaid, MCOs, and commercial payors</li>
<li>Experience with authorizations, denials management, and appeals</li>
<li>Ability to work independently on complex billing issues</li>
<li>High attention to detail and strong problem-solving skills</li></ul> 


Preferred Experience
<ul>
<li>Multi-clinic or multi-service healthcare experience</li>
<li>ABA authorization and treatment plan billing knowledge</li>
<li>EMR / billing system experience</li>
<li>Bachelor&rsquo;s degree (preferred, not required)</li></ul> 


What We Offer
<ul>
<li>Competitive pay based on experience</li>
<li>Stable, growth-focused healthcare organization</li>
<li>Exposure to multiple service lines (ABA, therapy, PDN)</li>
<li>Professional development and advancement opportunities</li>
<li>Benefits including PTO, health insurance, paid holidays , and 401K</li></ul></div>

Senior Revenue Cycle Specialist (RCM)

Fatorah Insurance Claims Settlement L.L.C

Job Title: RCM Manager Location: Qatar Company: AccumedJob Summary: Accumed is seeking an experienced Revenue Cycle Management (RCM) Manager to lead and optimize end-to-end RCM operations. The ideal candidate will have strong expertise in healthcare billing, claims management, and payer relations, with a focus on improving revenue performance and operational efficiency.Key Responsibilities:<ul><li>Oversee the full RCM cycle, including pre-authorization, claims submission, denial management, and collections</li><li>Monitor and improve KPIs such as claim acceptance rates, rejection rates, and days in A/R</li><li>Ensure compliance with Qatar healthcare regulations and payer requirements</li><li>Lead and mentor the RCM team, ensuring high performance and continuous improvement</li><li>Collaborate with internal teams and external stakeholders (providers, payers) to resolve billing issues</li><li>Analyze data and generate reports to support strategic decision-making</li></ul>Requirements:<ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Finance, or related field</li><li>5+ years of experience in Revenue Cycle Management, preferably in the GCC</li><li>Strong understanding of claims processing and payer systems</li><li>Experience with healthcare billing software and data analysis tools</li><li>Excellent leadership, communication, and problem-solving skills</li></ul>Job Types: Full-time, PermanentPay: From QAR1.00 per monthWork Location: In person

RCM Manager

Middlesex Health

<div>Position Highlights<ul><li>
Department: Finance</li><li>
Hours: 40.00 per week</li><li>
Shift: Shift 1</li></ul> 
This is an onsite position. 
Position Summary
The Senior Revenue &amp; Reimbursement Analyst provides oversight and support for Revenue Cycle workflow processes using data analytics. This position works closely with the Revenue Integrity team. The Senior Revenue &amp; Reimbursement Analyst assures all established billing, systems, and process requirements have been met in order to ensure timely and optimal reimbursement. Through the analysis of key performance indicator data, the Senior Revenue &amp; Reimbursement Analyst works to improve Revenue Cycle production and efficiency. The Senior Revenue &amp; Reimbursement Analyst recommends changes that will positively impact the Revenue Cycle and help meet industry benchmarks and meet A/R performance goals and productivity. The Senior Revenue &amp; Reimbursement Analyst will improve and implement internal controls over the revenue cycle and will work closely with IT on interface and system issues as required to improve the flow of data. The Senior Revenue &amp; Reimbursement Analyst may lead projects for the Revenue Cycle. This position will be responsible for complete revenue analytics including month end reporting of gross to net and accounts receivable valuation. 
Essential Duties &amp; Responsibilities<ul><li> 
Perform analysis of financial performance of the revenue cycle function to identify areas of opportunity</li><li>
Responsible for various standard, recurring reporting functions to support revenue cycle operational business needs</li><li>
Assists revenue cycle leaders in working closely with organizational stakeholders to improve financial performance based on analytic findings</li><li>
Completes regular root cause analysis of financial transactions</li><li>
Monitor key performance indicators for internal and external parties</li><li>
Prepares summary findings of analysis for department leadership review</li><li>
Cultivates internal relationships to assist in understanding department workflows</li><li>
Engage regularly with finance department leaders on improvement opportunities identified through data analysis</li><li>
Provides analytics for and supports special projects as needed (e.g. Underpayment review)</li><li>
Support investigation into claims patterns, payer mix evaluation and other strategic analytics to optimize payer performance.</li><li>
Analyze claims and other healthcare data to identify areas of opportunity and provide recommendations to business stakeholders</li><li>
Develop analytical models that are well-documented containing advanced formulas and functions that are used to evaluate historical trends, forecast future expectations, or draw conclusions</li><li>
Point person for month end revenue close including gross revenue and patient stat analysis and accounts receivable valuation calculations.</li><li>
Explore price transparency data and create meaningful cost of care comparisons to competitor networks</li><li>
Develop, improve, and streamline financial processes, reports, and planning tools</li><li>
Oversee and enhance institutional cost accounting practices</li><li>
Act as a liaison between the Finance division and other hospital areas as well as physician practices</li><li>
Collaborate with business leaders and business intelligence analysts to prepare multi-year business plans for new programs and initiatives to identify impact on clinical volumes, organizational and program financials, and evaluate return on investment</li><li>
Collaborates with Managers on gross revenue and other factors, then utilizes that information to calculate the budgeted net revenue.</li><li>
Works with the Manager on various cost report schedules as assigned.</li><li>
Monitor the status of Medicare Cost report appeals, including dates and working with the appropriate individuals on the issues. Creates a tracking mechanism to avoid missed opportunities.</li><li>
Completes gross revenue and stat analysis. Works with the various departments on issues.
</li><li>Collaborates on various statistical reporting based on the timeframes dictated by the survey. I.E. CHA, AHA, Magnet, DashBoard, etc.</li></ul> 
Minimum Qualifications<ul><li>
5 years in Hospital Reimbursement and Finance</li><li>
Bachelor's degree (preference for Business Analytics, Finance &amp; Economics, Mathematics, Statistics, Data Science, Health Economics)</li></ul> 
Preferred Qualifications<ul><li>
Prior experience with revenue cycle, financial reporting, revenue recognition, analytics and inferential statistics, and use of advanced Power BI tools</li></ul>
Preferred Education:<ul><li>
Masters in Business Administration, Healthcare Administration or related field</li></ul>
Certification/Credentials: 
Knowledge, Skills, Abilities:<ul><li>
Understanding of provider reimbursement, procedure codes (CPT-4, HCPCs), diagnosis codes (ICD-10), and health insurance business.</li><li>
Knowledge of payer contracts and contract interpretation</li><li>
Good communication skills</li><li>
Excellent computer skills</li><li>
Strong analytical skills</li><li>
Ability to work independently</li></ul> 
Comprehensive Benefits Offered<ul><li>
Competitive and affordable benefits package</li><li>
Shift Differentials</li><li>
Continuing Education assistance</li><li>
Tuition reimbursement</li><li>
Student Loan relief through Fiducius</li><li>
Quick commute access from I-84, Route 9 and surrounding areas</li></ul> 
About Middlesex Health
The Smarter Choice for your Career!
Come join one of Connecticut&rsquo;s Top Workplaces, and a Magnet designated organization! At Middlesex Health, we have a unique combination of award-winning talent, world-class technology, and patient-first care that's making health care better. Through our affiliation with the Mayo Clinic Care Network, Middlesex Health has access to the most advanced medical knowledge and research available.</div>

Senior Revenue and Reimbursement Analyst

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