Revenue Cycle Billing & Analyst, Specialist

Essential Functions:

• 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.

• Associate’s degree in healthcare administration, Business, or related field (Bachelor’s degree, preferred).
• Minimum 5‑7 years end‑to‑end Revenue Cycle Management experience (Medicaid/MCO and behavioral health, preferred).
• 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.