Care Compass Network · 15 hours ago
Revenue Cycle Billing & Analyst, Specialist (HYBRID)
Binghamton, NY, US
Full-time
Hybrid
Senior Level
$25/hr - $30/hr
5+ years expCare Compass Network is seeking a Revenue Cycle Billing & Analyst, Specialist to lead daily production workflows and manage accounts receivable performance. The role involves liaising with payers, conducting root-cause analysis for claims issues, and developing documentation to ensure compliance and operational efficiency.
Health CareNon ProfitProject Management
Responsibilities
Lead daily production workflows, worklists, and escalation management for claims creation, submission, reconciliation, and cash posting
Monitor and manage accounts receivable performance, ensuring timely follow-up, resolution, and payment posting
Liaise with payers and Managed Care Organizations (MCOs) to resolve systemic claims issues and drive process improvements
Drive root-cause analysis for top denial categories and implement prevention strategies
Develop, document, and maintain denial management playbooks, workflows, and training materials
Establish quality checks, audits, and controls to ensure accuracy and compliance across claims processes
Own end-to-end credentialing and payer enrollment processes, including CAQH maintenance, Medicaid and MCO rosters, taxonomy and NPI alignment, EFT/ERA setup, and clearinghouse connectivity
Ensure enrollment data accuracy to support clean claim submission and payment
Partner with Behavioral Health Hub leadership to ensure accurate service mapping, including LCSW scope of practice, CHW services, documentation standards, and encounter-to-claim integrity
Coordinate Business Solutions client assessments by collecting operational data, executing maturity scorecards, presenting findings, and implementing corrective actions
Maintain standard operating procedures (SOPs), audit documentation, and compliance artifacts aligned with regulatory and payer requirements
Support internal and external audits as needed
Build, maintain, and enhance Power BI dashboards and SQL queries/views to track first-pass yield (FPY), denial trends, A/R aging, and appeal outcomes
Explore and analyze data to uncover performance gaps, operational risks, and revenue optimization opportunities
Present insights and recommendations to leadership to support strategic and operational decision-making
Qualification
Required
Associate's degree in healthcare administration, Business, or related field
Minimum 5-7 years end-to-end Revenue Cycle Management experience
NYS Medicaid and Managed Care Organization experience
Knowledge of credentialing, enrollment, and managed care processes
Ability to perform root-cause analysis and translate findings into actionable improvements
Strong investigative skills: able to interpret EOBs/835s and reconcile to 837s
Excellent communication, facilitation, and stakeholder engagement abilities
Experience with Power BI, SQL, and data analytics for operational reporting
Strong organizational skills and ability to work independently
Preferred
Bachelor's degree
Minimum 5-7 years end-to-end Revenue Cycle Management experience (Medicaid/MCO and behavioral health)
CPC/CPMA or equivalent
Company
Care Compass Network
Care Compass Network is a non-profit organization that provides health and social care services.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Wayne Teris, MD, CPE, FAAFP
Chief Medical Officer
Company data provided by crunchbase