REVENUE CYCLE ANALYST II

CenterLight Health System; New York (NY); On-site; USD 80,000 - 90,000; Full time

Job summary

CenterLight Health System is seeking an experienced revenue cycle analyst to manage billing, analytics, and reconciliation across all lines of business. The role involves independent management of day-to-day revenue cycle operations, reporting on performance, and guiding junior staff.

The candidate will develop financial models and KPI dashboards (Tableau/Power BI) for senior leadership and collaborate with Enrollment, Actuarial, and CMS-related teams to ensure accuracy and compliance.

Qualifications

• Bachelor's degree required.
• Certified Professional Coder a plus.
• 3–5 years healthcare experience in a managed care setting.
• Proficiency in data analytics; SAS and SQL are required.
• Knowledge of CPT/ICD9/ICD10, HCPCS, DRG, RBRVS.
• Experience with MS Excel, Word, PowerPoint; claims processing systems.

Responsibilities

• Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
• Enter and reconcile insurance and member payments to A/R.
• Conduct full analytics on revenue operations for all CenterLight lines of business.
• Analyze payments (MMR, 820/834) and reconcile to billing files.
• Investigate Enrollment/Intake discrepancies for correction/rebilling.
• Coordinate with Enrollment on PDE rejections; assist CMS-related issues.
• Identify Surplus, NAMI, or Pool Trust balances and resolve issues.
• Prepare monthly GL entries related to revenue.
• Develop and maintain financial reporting and KPI dashboards in Tableau/Power BI.
• Mentor Revenue Cycle Analyst I staff and contribute to SOPs.

Skills

Data analytics

Multitasking

Communication skills

Detail-oriented

Team player

Education

Bachelor's degree

Tools

SAS

SQL

MS Excel

Word

PowerPoint

Tableau

Power BI

Job description

JOB PURPOSE

This position is responsible for CenterLight’s billing and revenue cycle analysis, reconciliation, and operational procedures while maintaining adherence to DOH and CMS guidelines.

This position independently manages day-to-day revenue cycle operations, reporting on revenue cycle functions, and provides guidance to Revenue Cycle Analyst I staff.

JOB RESPONSIBILITIES

• Perform weekly billing for Best Choice/Matter of Care in coordination with Coordinators and Payroll.
• Enter and independently reconcile insurance and member payments to A/R.
• Perform full analytics on all revenue operations for all Line of Business of Centerlight.
• Perform analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
• Independently investigate and resolve Enrollment/Intake discrepancies for correction/rebilling.
• Coordinate with Enrollment on PDE rejections and assist the Enrollment team with CMS-related issues.
• Coordinate with Enrollment on MSP letters and correction of discrepancies in ECRS.
• Identify members with Surplus, NAMI, or Pool Trust balances and resolve related issues.
• Work with the Enrollment/Intake team to resolve eligibility issues.
• Perform monthly MMR analysis and work with the CMS MAPD Helpdesk to open and resolve tickets.
• Coordinate with Dialysis providers to obtain 2728 forms and work with the CMS MAPD Helpdesk to activate member ESRD indicators.
• Prepare monthly GL entries related to revenue.
• Assist Actuarial with data analytics as needed.
• Develop and maintain financial reporting and analytics in Tableau/Power BI (including KPI dashboards) used by senior leadership to track actual results vs. target.
• Prepare ad hoc financial modeling, analysis, and projections.
• Serve as a resource and informal mentor to Revenue Cycle Analyst I staff on daily tasks, tools, and procedures.
• Contribute to process improvement initiatives and document standard operating procedures (SOPs).
• Create SQL queries/ store procedures for use by other members of the team.
• Work of developing process to identify revenue enhancing opportunities.
• Work on special projects as assigned.

Schedule

Schedule: Monday - Friday | 8:30AM – 5:30PM Weekly Hours: 40

QUALIFICATIONS

• Education: Bachelor's degree required.
• Certified Professional Coder a plus.
• Experience: 3-5 years of healthcare experience, managed care setting is required.
• Proficiency in data analytics, i.e. SAS, SQL is required.
• Claims adjudication and understanding of claims PPS is strongly preferred.
• Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is required.
• Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS.
• Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.
• Effective oral, written, and interpersonal communication skills are required.
• Able to multitask efficiently, effectively, and timely.
• Strong organizational skills and work ethic.
• Detail-oriented, professional and collaborative, a great team player.

PHYSICAL REQUIREMENTS

Individuals must be able to sustain certain physical requirements essential to the job.

• Standing – Duration of up to 6 hours a day.
• Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
• Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
• Agility/Fine Motor Skills – Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.).
• Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
• Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy.
• In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
• Cognitive Ability – Must be able to demonstrate good decision‑making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer

Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

Equal Opportunity Employer Statement

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information.

We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max)

$80,000.00 - $90,000.00

Recruitment Process Note

Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job‑related qualifications and applicable employment laws.

About C2Q Health Solutions

C2Q Health Solutions offers management services tailored to the needs and goals of healthcare providers. Drawing from our leadership team's experience in providing key administrative solutions to healthcare programs such as managed long‑term care, home care companies and other community health plans, C2Q’s expertise spans a full spectrum of functions that support an organization’s growth.