Revenue Cycle Analyst

Description

Reporting to the Revenue Integrity Manager, the Revenue Cycle Analyst plays a vital role in supporting both medical and pharmacy revenue operations by analyzing billing performance, monitoring KPIs, identifying trends in payer behavior, and producing actionable insights that drive operational improvements.

Representative Duties:

Revenue Cycle Analysis

• Track key revenue cycle metrics including AR days, clean claim rate, denial rate, payment lag, and net collection rate.
• Monitor payer mix, reimbursement trends, and denial volumes to identify systemic issues or inefficiencies.
• Evaluate trends in medical and pharmacy billing and proactively recommend solutions to increase collections and reduce payment delays.
• Develop actionable insights and strategies to support revenue cycle improvements across departments.
• Support the creation of appeals, workflows, and edits based on recurring denials or underpayments.

Data Reporting & Visualization

• Build and maintain real-time dashboards using tools like Power BI, Tableau, and Epic Reporting Workbench.
• Generate monthly, quarterly, and ad hoc reports to guide leadership decision-making.
• Present root cause analyses and financial trends in concise, visual formats tailored to varied stakeholders.
• Identify key drivers of variance in expected vs. actual reimbursements and contribute to forecasting models.

Strategic Planning & Optimization

• Analyze operational bottlenecks in charge entry, coding, claim submission, and denial workflows.
• Model performance outcomes and conduct what-if analyses to project financial impact of process changes.
• Provide insight into payer-specific behaviors and reimbursement policies that impact cash flow and AR aging.
• Participate in payer meetings and revenue cycle vendor check-ins to represent data findings and accountability measures.

Systems and Compliance Oversight

• Utilize Epic EHR and pharmacy billing platforms (e.g., ComputerRx) to extract, validate, and analyze billing data.
• Ensure compliance with billing standards, HIPAA regulations, and payer-specific requirements.
• Contribute to chargemaster reviews and documentation audits with insight into revenue impact.

Performs other related duties as required

Requirements

• Ability to work harmoniously and effectively with colleagues, patients, clients and vendors across the spectrum of diversity, including but not limited to race, ethnicity, color, gender identity, sexual orientation, age, socio-economic status, national origin and immigrant status, religious or spiritual identity, disability (physical, mental, emotional and developmental), veteran status, and/or limited English proficiency.
• Willingness to contribute towards Fenway’s efforts in becoming an anti-racist organization and promoting a culture dedicated to ongoing development in service of humility, equity, diversity, inclusion, and belonging, where differences are acknowledged and valued.
• 1–3 years of experience in revenue cycle analytics, revenue integrity, or healthcare billing and reporting roles.
• Hands-on experience with Epic (preferably Clarity or Reporting Workbench) and pharmacy billing systems.
• Familiarity with healthcare billing standards (i.e., CPT, HCPCS, ICD-10), payer reimbursement methodologies, denial management, and claims processing in either ambulatory, pharmacy, or FQHC settings.

Preferred Qualifications:

• Associate degree in Business, Healthcare Administration, Informatics, Finance, or related field.
• Certified Revenue Cycle Representative (CRCR) or equivalent revenue cycle certification.
• Understanding of FQHC-specific revenue cycle nuances and value-based care reimbursement.
• Wizard level Excel skills

Physical Requirements:

Ability to meet the following physical requirements with or without reasonable accommodations:

• Sit at a computer station for extended periods of time
• Ability to be on a keyboard for extended periods of time