Revenue Cycle Analyst II

Role Overview:

The Revenue Cycle Analyst II is responsible for supporting the End-to-End (E2E) Premium Revenue Cycle, ensuring revenue is accurate, complete, timely, and compliant from enrollment through payment, reconciliation, reporting, and resolution.  This role is responsible for working with dialysis and medical facilities to complete CMS-2728 ESRD forms. This role also ensures data integrity across upstream and downstream systems by monitoring, investigating, and resolving discrepancies, while recommending corrective actions to support accurate financial reporting and operational performance. The analyst partners with cross-functional teams to resolve issues that impact financial results and supports enterprise oversight, governance, and reporting needs by validating data across multiple sources, contributing to process improvements that strengthen revenue controls and transparency across the full premium revenue lifecycle, and using technical tools such as, SQL, and Databricks.

Work Arrangement:

• Remote within the United States, working Eastern Standard Time
• For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
   

Responsibilities:

• Analyze and interpret financial and membership data across the End-to-End (E2E) Premium Revenue Cycle from sources including 834 enrollment files, 820/835/member payment files, Lock-in files, Jiva, the Data Warehouse, Data Lake, and the Facets system to identify discrepancies, determine root causes, and recommend corrective actions.
• Prepare and maintain discrepancy reports, state reports, and other plan-specific financial reports to identify, reconcile, and control variances.
• Develop, maintain, and enhance databases, queries, joins, tables, and forms; create SQL queries, stored procedures, user-defined functions, and related functional and technical documentation; and demonstrate proficiency in Databricks to support data extraction, transformation, analysis, and reporting.
• Generate and update monthly reconciliation reports, audit support materials, and other required reporting; review results for material differences and escalate issues to management when appropriate. 
• Maintain working knowledge of 834, 820, 835, and 837 companion guides, system notices, and member documentation; advise management on actions needed to meet state and business requirements. 
• Provide training, guidance, and ongoing operational support across lines of business and products, ensuring consistent understanding and execution of Revenue Cycle Management processes, systems, and requirements. 
• Meet monthly and quarterly deadlines while providing support to Accounting, EDI, Enrollment, Encounters, Statutory, Actuarial, and other business partners.
• Attend and lead departmental and cross-functional meetings to facilitate collaboration, communicate key updates, drive issue resolution, and ensure alignment on priorities, decisions, and action items.
• Provide backup support for the Lead Analyst by assisting with priority assignments, operational oversight, issue escalation, reporting, and coordination of departmental activities to ensure continuity of essential functions
• Contribute to annual departmental goals and respond to stakeholder requests for analysis and information within established timeframes.
• Support innovation initiatives aligned with enterprise governance by identifying process gaps, control weaknesses, and opportunities for automation
• Strong analytical skills to identify financial trends and anomalies. 
• Partner with internal departments to ensure compliance with contractual requirements.
• Participate in testing and design requirements and performs testing of new releases for internal applications. 
• Balance multiple competing priorities while meeting critical deadlines.
• Independent work capability combined with collaborative mindset
• Perform other duties as assigned. 

Education/Experience:

• Bachelor’s Degree.
• Minimum 4 years of experience.

Other Skills:

• Intermediate understanding of Managed Care practices and policies, such as but not limited to;  

  • Back-end Business practices, Claims Processing/Clinical Coding, Billing, and Payments

• Strong analytical skills and Medicaid/Medicare revenue cycles is a must. 

• Ability to identify issues, research, investigate, and document findings.

• Strong communication (both written and verbal), analytical and problem-solving skills. 

• Strong organizational skills with the ability to coordinate several projects simultaneously. 

• 3 years experience in healthcare, finance and/or financial reporting, preferred. 

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.