The opportunity
The Associate Revenue Cycle Analyst – Billing serves as a subject matter expert and analytical resource within the Clean Claim Team (CCT), focused on ensuring claims are accurately billed, successfully submitted, received, and accepted by payers before entering the downstream denial process.
What you'll do
Serve as a subject matter expert for clean claim submission and front-end: billing processes, with a strong understanding of the claim lifecycle from claim creation through payer receipt and acceptance.
Analyze claim rejections and operational data to identify trends, recurring: issues, root causes, and opportunities to improve clean claim performance.
Investigate EDI and clearinghouse rejections, duplicate submission issues,: incorrect or missing ICN information, prior authorization-related rejections, provider enrollment and NPI registration issues, patient demographic errors, and other claim submission barriers.
Research rejection reasons, determine the root cause, and provide all of the: necessary information, documentation, system corrections, or operational changes to the appropriate cross-functional teams in order to resolve them
Evaluate identified issues beyond the individual claim to determine the: broader claim population, payer, workflow, or business processes impacted.
Identify upstream causes of claim rejections and develop sustainable: solutions designed to prevent recurrence and reduce downstream denials.
What they're looking for
- Bachelor's degree in business, healthcare, analytics, or a related field preferred.
- –3+ years of experience in medical billing, claims operations, revenue cycle: management, insurance collections, or a related healthcare function.
- Strong understanding of healthcare revenue cycle processes and the claim: lifecycle, particularly claim creation, submission, clearinghouse processing, payer acceptance, rejection, and denial.
- Experience investigating claim rejections, EDI transactions, clearinghouse: issues, payer requirements, provider enrollment, or other front-end billing issues strongly preferred.
- Working knowledge of medical billing and coding concepts, including: CPT/HCPCS, ICD-10, modifiers, authorization requirements, payer requirements, and claim identifiers.
- Proficiency with Microsoft Excel, including pivot tables, lookup functions,: data manipulation, and analysis of large datasets.
- Working knowledge of SQL and experience using a data warehouse or analytics: platform such as Snowflake. Candidates should be able to independently obtain the data needed to answer business questions using SQL, including effectively leveraging AI-assisted query development when appropriate.
- Demonstrated ability to analyze data, recognize patterns, investigate root: causes, and translate findings into actionable operational solutions.