Revenue Cycle Compliance & Analytics Analyst

Highmark Health; Madison (WI); On-site; USD 39,000 - 61,000; Full time

Job summary

Allegheny Health Network is seeking a Revenue Cycle Analyst to perform reporting and analysis of the revenue cycle, assist with system issues, audits, and guidance on billing processes. You will partner with leaders to improve documentation and ensure compliance.

The role involves root cause analysis, monitoring and education across departments, supporting medical necessity determinations, CDM integrity, and collaboration with compliance and finance to drive efficiency.

Qualifications

• High School/GED required.
• 1-3 years in hospital or physician revenue cycle, billing or coding.
• Bachelor's Degree in Business, Healthcare or related field preferred.
• 1 year in Project Management preferred.
• 1 year in a Epic-billing environment preferred.

Responsibilities

• Responsible for financial, statistical and operational projects; present detailed analysis of A/R performance and other financial reports and related outcomes/trends.
• Researches and validates clinical data used to support medical necessity of billed services; conducts quality assurance reviews of billing components and documentation.
• Reviews outcomes with leadership and influences adjustments to facilities and practices; assists with maintaining the CDM and software.
• Performs ad hoc consultative research on Revenue Cycle regulatory risk; coordinates meetings and supports RAC and payer audit appeals.
• Monitors Revenue Cycle issues and conducts audits; identifies gaps and opportunities for improvement.
• Provides ongoing education to departments and staff on PM workflows, coding and compliance.
• Collaborates with Compliance, Budget Office, Patient Accounts and other departments on revenue management initiatives.
• Other duties as assigned.

Education

High School/GED

Bachelor's Degree in Business, Healthcare or related field

Job description

Allegheny Health Network is seeking a Revenue Cycle Analyst to perform reporting and analysis of the revenue cycle, assist with system issues, audits, and guidance on billing processes. You will partner with leaders to improve documentation and ensure compliance.

The role involves root cause analysis, monitoring and education across departments, supporting medical necessity determinations, CDM integrity, and collaboration with compliance and finance to drive efficiency.