Basic Function and Scope of Responsibility:
The Senior Revenue Cycle Analyst is responsible for performing revenue cycle, billing, reimbursement, payer contract administration, and analytical functions designed to maximize reimbursement, improve collections performance, reduce denials, and optimize revenue cycle processes across Eurofins Transplant Genomics, LLC and other Eurofins U.S. Clinical Diagnostic business units as assigned.
This role combines traditional billing and accounts receivable responsibilities with advanced analytical and business support functions. The Revenue Cycle Analyst serves as a subject matter expert in claims research, payer reimbursement methodologies, contract administration, revenue cycle reporting, underpayment recovery, denial management, and process improvement. The position utilizes laboratory billing systems, data warehouses, reporting tools, and advanced Excel-based analytics to identify reimbursement opportunities, investigate payment variances, develop management reporting, and support implementation of operational and system enhancements.
This individual works closely with Billing Operations, Finance, Credentialing, Payor Enrollment, Information Technology, Sales, Client Services, and Business Leadership to improve revenue cycle performance and ensure optimal reimbursement outcomes.
Essential Job Duties:
Billing Operations and Accounts Receivable Management
- Process, review, and monitor commercial, government, managed care, client, and patient billing activities.
- Review and resolve billing exceptions, claim rejections, denials, payment variances, and reimbursement discrepancies.
- Research and correct payer, demographic, coding, eligibility, authorization, and billing issues impacting reimbursement.
- Work aging accounts and unresolved claims to maximize collections and reduce outstanding accounts receivable.
- Submit corrected claims, appeals, adjustments, and rebills as necessary.
- Ensure compliance with billing policies, payer requirements, contractual obligations, and applicable regulatory standards.
- Collaborate with internal and external stakeholders to resolve complex reimbursement issues.
Claims Research and Revenue Optimization
- Conduct detailed claims-level analysis to identify opportunities for reimbursement improvement and revenue recovery.
- Investigate denied, underpaid, overpaid, and unresolved claims to determine root cause and recommend corrective action.
- Analyze reimbursement outcomes and payment trends across payers, clients, testing services, and business units.
- Identify reimbursement leakage, operational inefficiencies, billing system issues, and payer-related challenges that negatively impact revenue realization.
- Develop recommendations to improve collections performance, reduce denials, accelerate cash flow, and maximize reimbursement.
- Support denial prevention initiatives through data analysis and process redesign.
- Assist with complex appeal strategies and recovery efforts for large-dollar or systemic reimbursement issues.
Payor Contract Management and Reimbursement Administration
- Maintain and perform regular audits of payer master records to ensure accurate setup of financial classes, contracting status, payer identifiers, effective dates, termination dates, reporting classifications, and reimbursement categories.
- Research, develop, maintain, and update reimbursement schedules for contracted and non-contracted commercial, government, and managed care payers.
- Analyze payer contracts, reimbursement methodologies, fee schedules, and payment arrangements to ensure accurate expected reimbursement calculations.
- Load, maintain, validate, and periodically audit fee schedules and reimbursement tables within laboratory billing systems and related applications.
- Monitor payer compliance with contractual reimbursement terms and identify payment variances requiring investigation.
- Review payer performance and identify trends related to denials, underpayments, overpayments, reimbursement inconsistencies, and contract compliance concerns.
- Collaborate with Credentialing and Payor Enrollment personnel to resolve payer setup, reimbursement, enrollment, and contract-related issues.
- Support operational implementation of new payer contracts, amendments, reimbursement methodologies, and contract renewals.
Reporting, Analytics, and Business Intelligence
- Develop, maintain, and distribute recurring and ad hoc reports related to billing performance, collections, accounts receivable, denials, reimbursement trends, contract compliance, and operational effectiveness.
- Extract, validate, analyze, and reconcile data from billing systems, data warehouses, and supporting applications.
- Utilize advanced Microsoft Excel functionality to perform detailed analyses and create reporting solutions.
- Develop dashboards, scorecards, key performance indicators, and management reporting tools used to support operational and financial decision-making.
- Prepare monthly payer performance reports identifying reimbursement trends, denial patterns, underpayment opportunities, financial risks, and corrective action plans.
- Conduct root-cause analyses of operational and financial issues impacting revenue cycle performance.
- Present findings and recommendations to management in a clear and actionable manner.
- Maintain payer mapping and related reimbursement data within enterprise reporting and business intelligence platforms, including the Ascend Data Warehouse and other designated systems.
Systems Support, Testing, and Process Improvement
- Identify opportunities to improve revenue cycle workflows, billing processes, reimbursement accuracy, reporting capabilities, and operational efficiency.
- Develop business requirements and process documentation supporting billing and reimbursement initiatives.
- Partner with Information Technology, software engineering teams, vendors, and business stakeholders to design, test, validate, and implement system enhancements.
- Participate in user acceptance testing, validation activities, and deployment efforts associated with billing systems, revenue cycle applications, and reporting solutions.
- Work with STARS software engineers and other technology partners to enhance payer contract management functionality and related processes.
- Monitor the effectiveness of implemented solutions and measure resulting operational and financial improvements.
- Support automation initiatives and continuous improvement projects throughout the revenue cycle function.
Cross-Functional and Multi-Business Unit Support
- Provide billing, reimbursement, reporting, contract administration, and revenue cycle analytical support for Eurofins Transplant Genomics and other Eurofins U.S. Clinical Diagnostic business units as assigned.
- Partner with business leaders to identify opportunities for revenue cycle standardization and best practice implementation across business units.
- Participate in enterprise revenue cycle initiatives, strategic projects, integrations, and operational improvements.
- Assist in training personnel on billing policies, reimbursement methodologies, reporting tools, and process changes.
- Serve as a subject matter expert for reimbursement analytics and payer performance management.
Other Responsibilities
- Maintain confidentiality of patient, client, company, and financial information in accordance with company policies and applicable regulations.
- Demonstrate professionalism and commitment to Eurofins values and quality standards.
- Perform additional responsibilities, special projects, and duties as assigned.
Knowledge, Skills, and Abilities
- Strong understanding of healthcare billing, laboratory billing, collections, and accounts receivable processes.
- Knowledge of commercial insurance, Medicare, Medicaid, managed care, and other third-party payer reimbursement methodologies.
- Strong understanding of payer contract administration and reimbursement modeling.
- Ability to analyze actual versus expected reimbursement and identify payment variances.
- Advanced analytical thinking and problem-solving capabilities.
- Strong financial, operational, and data analysis skills.
- Ability to identify trends, determine root causes, and recommend actionable solutions.
- Advanced Microsoft Excel proficiency, including:
- Pivot Tables
- XLOOKUP/VLOOKUP
- Power Query
- Complex formulas
- Data manipulation
- Dashboard development
- Trend analysis
- Experience working with billing systems, revenue cycle software, and reporting tools.
- Ability to translate complex data into meaningful business recommendations.
- Strong project management, organizational, and prioritization skills.
- Excellent written, verbal, and presentation skills.
- Ability to manage multiple projects and deadlines simultaneously.
- Ability to work independently while collaborating effectively across departments.
Essential Experience, Knowledge, Skills and Abilities:
- Minimum of 3 to 5 years of healthcare billing, reimbursement, revenue cycle, claims management, or related experience.
- Experience analyzing billing, collections, denial, reimbursement, and accounts receivable data.
- Experience developing operational and financial reports.
- Advanced Microsoft Excel experience required.
- Laboratory billing experience.
- XIFIN experience.
- Experience with Ascend Data Warehouse or similar business intelligence platforms.
- Experience with Power BI, Tableau, SQL, or other reporting and analytics tools.
- Experience with payer contract administration and reimbursement schedule maintenance.
- Experience supporting multiple business units in a shared-services environment.
- Revenue cycle, coding, billing, or healthcare finance certifications (CRCR, CPB, CPC, HFMA, or equivalent).
- Excellent customer service skills, with a focus on professionalism
- Ability to solve problems, prioritize tasks, and multitask effectively
- Goal-oriented mindset with excellent time management and organizational skills
- Strong interpersonal communication skills, including the ability to interact efficiently with individuals at all levels in an organization
- Strong level of empathy & patience
- Excellent verbal and written communication skills
- Attention to detail, accuracy, and time management
- Proficiency in PC-based software such as Microsoft Excel, Teams, iPhone, Adobe, and associated applications
- A fundamental understanding of medical billing concepts
- Knowledge of Medicare, Medicaid, and commercial insurance
- Familiarity with HIPAA (Health Insurance Portability and Accountability) privacy requirements
- Knowledge of Availity and eligibility portals and medical terminology
- Follow up on missing or incorrect information so patients receive the right reimbursement.
- Document account activity using correct medical and billing codes.
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Be investigative to find necessary information, if needed
- Ability to handle multiple priorities and meet deadlines
- Ability to work independently and as part of a team in a fast-paced environment
- Demonstration of self-motivation and ownership of assigned work
- A high level of professionalism and confidentiality in handling sensitive information is imperative.
- Ability to self-start and work independently as well as respond to STAT requests in a timely manner
- Excellent verbal & written communication skills.
- Analytical judgment, problem-solving skills, accuracy, and strong orientation.
- Bilingual experience a plus.
Physical Requirements:
- Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate a keyboard and other office equipment, use a telephone, access file cabinets and other items stored at various levels, including overhead.
- Ability to speak and hear well enough to communicate clearly and understandably with sufficient volume to ensure an accurate exchange of information in normal conversational distance, over the telephone, and in a group setting.
- Ability to continuously operate a personal computer for extended periods of time (4 or more hours)
- Mental acuity sufficient to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgments and decisions.
- Ability to travel (as needed)
The essential physical and mental requirements described here are representative of those that must be met by an employee to successfully perform the job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Schedule:
What we offer:
- Excellent full time benefits including comprehensive medical coverage, dental, and vision options
- Life and disability insurance
- 401(k) with company match
- Paid vacation and holidays
Eurofins USA Clinical Diagnostics is a Disabled and Veteran Equal Employment Opportunity employer.