Job Description
**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.
**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.
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