Revenue Cycle Analyst Lead

The Revenue Cycle Lead is responsible for leading and coordinating complex End-to-End (E2E) Premium Revenue Cycle activities to ensure revenue is accurate, complete, timely, and compliant from enrollment through payment, reconciliation, reporting, and resolution. This role provides day-to-day operational leadership, oversight of reconciliation and reporting processes, serves as a subject matter expert for HIPAA 5010 transactions (820, 835, 834, and 837), and drives cross-functional issue resolution. 

The Revenue Cycle Lead partners with Accounting, Enrollment, EDI, Encounters, Actuarial, Statutory Reporting, Information Solutions, and business stakeholders to identify root causes, implement corrective actions, and improve processes across the premium revenue lifecycle. This role utilizes advanced analytical and technical skills, including SQL and Databricks, to support data governance, automation initiatives, operational excellence, financial integrity, and continuous process improvement. The Lead provides mentorship and guidance to analysts and serves as a primary escalation point for complex operational and reconciliation issues.

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, Lead and oversee premium revenue reconciliations across 834 enrollment files, 820/835 payment files, member payments, Lock-In files, Jiva, Data Warehouse, Data Lake, Databricks, and Facets systems.
• Serve as the primary resource for complex discrepancy research, root-cause analysis, issue resolution, and financial impact assessments.
• Strong analytical skills to identify financial trends and anomalies.
• Coordinate daily operational activities, assign work priorities, monitor workloads, and ensure completion of critical deliverables and regulatory reporting requirements.
• Partner with Vendors and Contractors to develop whatever is needed for member facing materials based upon contractual requirements.
• Develop, maintain, and optimize SQL queries, Databricks workflows, databases, dashboards, automation solutions, and reporting tools to improve efficiency and data quality.
• Review reconciliation results, audit support documentation, state reports, and management reporting for completeness, accuracy, and compliance.
• Lead testing efforts for new system implementations, enhancements, regulatory changes, and process improvements.
• Mentor analysts, provide training, facilitate knowledge sharing, and support onboarding of new team members.
• Supports management when needed, including leading team meetings, monthly reporting and all other requests
• Identify and implement process improvements, automation opportunities, and control enhancements in partnership with the Automation & Innovation team.
• 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.
• Perform other duties as assigned.

Education/Experience:

• Bachelor’s Degree.
• 5 or more years experience.

Other Skills:

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.