Job Type
Full-time
Description
The Revenue Cycle Analyst supports payment integrity programs for health plan clients by managing the downstream financial and operational activities that occur after claim audit or validation. This role focuses on tracking audited claims through recovery, adjustment, invoicing, and reporting processes to ensure identified savings are accurately realized, reconciled, and communicated.
This position is fully remote with occasional trips to the office required. Preference will be given to candidates within driving distance to the corporate office in Plymouth Meeting, PA.
Requirements
Revenue Cycle & Recovery Operations
- Manage post-audit claim inventory across multiple clients, products, and workflows (pre-pay, post-pay, Pre-ProgenyHealth NICU Claims Review).
- Track claims from audit determination through recovery, adjustment, offset, or denial resolution.
- Reconcile client-reported recoveries, offsets, and adjustments to auditor findings.
- Identify and resolve discrepancies where recoveries do not directly align to original audit findings.
- Support recovery calculations when savings are not explicitly reported and must be derived from claims data.
Client & Provider Communication Support
- Coordinate the generation and tracking of audit determination letters, overpayment notifications, and related correspondence.
- Maintain letter trackers to support timing requirements, regulatory compliance, and client workflows.
- Respond to client inquiries related to recovered amounts, claim status, and financial outcomes.
Financial Reconciliation & Invoicing
- Prepare pre-invoice and invoice support documentation based on recovered or adjusted claim values.
- Partner with Finance to validate invoicing accuracy and timing.
- Support revenue recognition by ensuring recoveries meet contractual and audit criteria.
- Reconcile invoice totals to claim-level recovery detail.
Reporting & Data Management
- Produce recurring and ad hoc reports on recovery performance, inventory status, and financial outcomes.
- Maintain accurate claim-level documentation to support audits, appeals, reconsiderations, and client reporting.
- Track claim iterations, adjustments, reversals, and reconsiderations across multiple data feeds.
Process Improvement & Quality
- Identify workflow gaps, data issues, or process inefficiencies impacting recovery realization.
- Collaborate with Audit, Coding, Clinical, Client Success, and Product teams to improve revenue cycle workflows.
- Participate in quality assurance reviews to ensure consistency, accuracy, and compliance.
Qualifications:
Required
- 3+ years of experience in healthcare revenue cycle, payment integrity, claims operations, or recovery analytics.
- Strong understanding of post-pay and pre-payment claims review workflows.
- Experience working with health plans, TPAs, or healthcare vendors (payer-side experience preferred).
- Proficiency analyzing medical claims data, adjustments, offsets, and recovery files.
- Advanced Excel skills; ability to reconcile complex datasets.
- Strong analytical, organizational, and problem-solving skills.
- Excellent written and verbal communication skills.
Preferred
- Experience supporting payment integrity, audit, or overpayment recovery programs.
- Familiarity with DRG, inpatient, and high-dollar claim review concepts.
- Knowledge of payer regulations and audit requirements (e.g., Medicare, Medicaid, commercial plans).
- Experience working in multi-client vendor environments with varied workflows.
- Exposure to appeals, reconsiderations, or provider dispute processes.
Position level to be determined based on qualifications and experience.
Benefits
Some of the benefits we offer our team are:
- Paid Time Off
- Paid Parental Leave
- Medical, dental, vision benefits
- 401K with company match
- Short- and Long-Term Disability
- Group Life Insurance
- Tuition reimbursement
- Casual work environment