Revenue Cycle Analyst

2 weeks ago

Newtown Square, PA, United States AmeriHealth Caritas Full time

Role Overview: The Revenue Cycle Analyst is responsible for the accurate and timely preparation and analysis of HIPAA 5010 financial reconciliations and monthly premium payment files, including 820, 835, 837, and 834 membership files. This role requires skills in managing, maintaining, and manipulating data in Microsoft Access, Microsoft SQL, and Databricks. The Analyst is responsible for assigned lines of business. Additionally, the Analyst may be accountable for maintaining reinsurance processes as appropriate.

Work Arrangement:

  • Hybrid - The associate must be in the office at least three (3) days per week at our Newtown Square, Pennsylvania (PA) location.

Responsibilities:

  • Analyze and interpret financial data from sources such as 834 enrollment, membership, and maternity events; payment/financial files; Lock-in files; Jiva; Data Warehouse; Dats Lake; and the Facets System to identify discrepancies, determine the best approach to resolution

  • Maintains and creates databases, queries, joins, tables, and forms; designs and creates SQL queries and stored procedures, technical specifications, and user-defined functions, writing functional and technical specification documents.

  • Prepare and maintain discrepancy reports, state reporting, and other plan-specific financial reporting to identify, reconcile, and control variances for maximum profitability

  • Generates and updates reports for monthly reconciliation, financial audits, and all other required reporting; Analyzes completed reports to ensure there are no material differences that should be escalated to management for review.

  • Become familiar with and understand existing and new 834 (enrollment/membership) and 820, 835, 837 (payment/financial) companion guides, system notices, and member documentation, adherence to requirements; advise management on needed actions to comply with state requirements

  • Responsible for meeting all monthly and quarterly deadlines and providing full support to other areas such as Accounting, EDI, Enrollment, Encounters, Statutory, and the Actuarial departments

  • Participates in the completion of all designated annual goals for the Financial Services department.

  • Support stakeholders explorations and information requests within departmental timeframes

  • Prepared for onsite audits of all tasks requiring process explanation and accountability

Education & Experience:

  • Bachelor's degree preferred; High School/GED required.

  • 1 to 3 Revenue Code Mapping, Data Analysis, Data warehousing, translated 5010 EDI files, financial reporting, electronic remittance advice (codes), and related financial analysis experience

  • 2 years of experience in healthcare finance and/or financial reporting, preferred

  • Proficient in Databricks, Microsoft SQL Server, Oracle, MySQL, and SQL Server Reporting Services

  • Proficiency in Excel, Access, and Monarch preferred

  • Fluent in file data mapping, both in Access and SQL

Skills & Abilities:

  • Solid analytical skills and problem-solving skills with the ability to articulate and communicate recommendations for enhancement

  • Strong working knowledge of business computer programs, applications, and systems, database structures, and data files required.

  • An understanding of clinical coding or claims processing is preferred.

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

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

  • The ability to work on multiple tasks with competing priorities demonstrates strong subject matter expertise in the states and business processes that they support

  • Ability to work accurately and independently as well as comfortable interacting collaboratively with all levels of business; open-minded to consider alternative ideas and next steps for remediation.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

  • Maternity Revenue Analyst

    2 weeks ago

    Newtown Square, PA, United States AmeriHealth Caritas Full time

    Responsibilities: Under the general supervisor of the Manager Accounts Receivable, the analyst is responsible for identifying, validating, submitting and reconciling all maternity submissions accurately and timely for all applicable lines of business. Based on State specific methodology and timeframes- i.e. weekly, monthly; accurately submit maternity...

  • Assoc Analyst

    1 week ago

    Newtown Square, PA, United States Sunoco LP Full time

    Sunoco LP is a leading energy infrastructure and fuel distribution master limited partnership operating across 47 U.S. states, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements the Partnership's fuel...

  • Assoc Analyst

    2 weeks ago

    Newtown Square, PA, United States Sunoco LP Full time

    Sunoco LP is a leading energy infrastructure and fuel distribution master limited partnership operating across 47 U.S. states, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements the Partnership's fuel...

  • Assoc Analyst

    1 week ago

    Newtown Square, PA, United States Sunoco LP Full time

    Sunoco LP is a leading energy infrastructure and fuel distribution master limited partnership operating across 47 U.S. states, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements the Partnership's fuel...

  • Application Architect

    2 weeks ago

    Newtown Square, PA, United States AmeriHealth Caritas Health Plan Full time

    TITLE:Application Architect (Job ID 434013) LOCATION: Newtown Square, PA (remote work option 100% of the time) DUTIES: Develop, configure, code and test programs from specifications using SQL/SQL Server, .Net, and SSIS technologies. Interface with business analysts, project managers and clients to translate and clarify business, technical requirements....

  • Chief Financial Officer

    2 weeks ago

    Kennett Square, PA, United States Jamie Grayem Full time

    Chief Financial Officer (CFO), Healthcare Facility$140K-180K+ Signing Bonus + Paid Relocation + Full Benefits + Signing Bonus Role Overview: Strategic Financial Leadership The Chief Financial Officer (CFO) is an integral member of the senior leadership team, responsible for the overall financial and fiscal management of a major healthcare facility. This is a...

  • Revenue Cycle Director: Patient Accounts

    3 weeks ago

    Journal Square, United States CarePoint Health Management Associates Full time

    A leading healthcare organization in New Jersey seeks a Patient Accounts Manager to oversee accounts receivable functions, manage financial operations, and drive improvements in the revenue cycle. The ideal candidate will have a Bachelor's degree, 4-6 years of relevant experience, strong communication skills, and proficiency in Microsoft Excel and Meditech....

  • Analyst - Business Development

    1 week ago

    Newtown Square, United States Energy Transfer Full time

    , recognized by Forbes as one of America's , is dedicated to responsibly and . We are driven to inspire our employees to create superior value for our customers, our investors, a and to the community where we have long-standing commitments to causes including MD Anderson Children’s Cancer Hospital, The Salvation Army, The American Red Cross, Ronald...

  • Accounts Receivable Specialist

    4 weeks ago

    Newtown Square, United States Main Line Health Full time

    Could you be our next Accounts Receivable Specialist at Ellis Preserve in Newtown Square? Why work as a Accounts Receivable Specialist with Main Line Health? Make an Impact! Tracking insurance payments in EPIC and resolving payment issues is a critical role at our organization. Our Accounts Receivable Specialists don't just track numbers; they work on...

  • IT Systems Analyst

    4 weeks ago

    Newtown, United States Employment Opportunities Inc Full time

    IT Systems Analyst Bucks County Community College is seeking a skilled IT Systems Analyst to join our IT team. As the IT Systems Analyst, you will need extensive knowledge of programming languages, scripting, and software development life cycle frameworks. You must be familiar with a variety of operating systems and platforms and bring an analytical mindset...

  • Accelerated Sales Engagement Senior Specialist

    2 weeks ago

    Newtown Square, United States SAP Full time

    We help the world run betterAt SAP, we keep it simple: you bring your best to us, and we'll bring out the best in you. We're builders touching over 20 industries and 80% of global commerce, and we need your unique talents to help shape what's next. The work is challenging – but it matters. You'll find a place where you can be yourself, prioritize your...

  • Director of Patient Accounts

    3 weeks ago

    Journal Square, United States CarePoint Health Management Associates Full time

    About Us CarePoint Health is one of New Jersey’s leading health care systems comprised of three long-standing and highly-regarded hospitals –Bayonne Medical Center, Christ Hospital, and Hoboken University Medical Center. CarePoint united these three area hospitals to provide 360 degree coordinated care by integrating the medical facilities and physician...

  • Application Architect

    2 weeks ago

    Newtown Square, Pennsylvania, United States AmeriHealth Caritas Full time

    TITLE:;;;;;;;;;;;;;;;;;;;;;;Application Architect (Job ID LOCATION:;;;;;;;;;;;;;; Newtown Square, PA (remote work option 100% of the time)DutiesDevelop, configure, code and test programs from specifications using SQL/SQL Server, .Net, and SSIS technologies. Interface with business analysts, project managers and clients to translate and clarify business,...

  • Senior Analyst, FP&A

    4 hours ago

    Times Square, WA, United States LevelTen Energy Full time

    Position Title: Senior Analyst, FP&A Role Purpose LevelTen Energy’s mission is to accelerate the energy transition by facilitating frictionless transactions. As the leading provider of renewable transaction infrastructure, we deliver the cloud-based software, centralized supply, automated analytics, and transaction expertise required to power the renewable...

  • Director of Workers Compensation

    11 hours ago

    Newtown Square, United States Martin & Company Full time

    Martin & Company is a leading insurance advisory and consulting firm celebrating over 30 years in business. We support many national, regional, and local insurance carriers and managing general agents (MGA) throughout the US. Our insurance services focus on our clients’ most important initiatives and opportunities: compliance, capacity, resources,...

  • Chief Financial Officer

    4 hours ago

    Kennett Square, United States Jamie Grayem Full time

    Chief Financial Officer (CFO), Healthcare Facility$140K-180K+ Signing Bonus + Paid Relocation + Full Benefits + Signing Bonus Role Overview: Strategic Financial Leadership The Chief Financial Officer (CFO) is an integral member of the senior leadership team, responsible for the overall financial and fiscal management of a major healthcare facility. This is a...