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PathGroup · 2 days ago

Revenue Cycle Analyst

United States

Full-time

Remote

Entry, Mid Level

PathGroup is seeking a Revenue Cycle Analyst who combines strong analytical skills with a passion for improving operational performance. The role involves analyzing payer data, resolving claim denials, and transforming insights into actionable strategies that drive revenue growth.

BiotechnologyHealth CareHealth Diagnostics

Responsibilities

Analyze revenue cycle data across internal systems and payer portals to identify trends, patterns, and performance gaps to ensure timely and accurate reimbursement

Monitor claims, cash collections, denials, reimbursements, and payer behavior through daily and weekly reporting

Track KPIs such as days in A/R, denial rates, net collections, reimbursement timelines, credit balances, and payor policies such as NCD, LCD and other coverage policies impacting revenue

Responsible for prioritizing and managing to resolution denied claims with third party payors. Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility, and authorization requirements. Identify appeal opportunities, providing compelling appeal language for third party payers

Conduct root-cause analysis for denials, rejections, underpayments, and delayed payments, recommending actionable solutions. Maintains action plans for improvements

Partner closely with internal stakeholders to improve clean-claim rates, streamline workflows, and enhance overall efficiency

Create SOP’s, process flows and documentation to enhance denial processing efficiency

Partner with Managed Care on payer negotiations and behavior

Support ad hoc data requests and cross-functional initiatives for revenue cycle leadership

Compiles, maintains, and distributes reports to management on success of appeals and root cause analysis. Serves as subject matter expert of payer requirements