Associate Revenue Cycle Analyst – Billing

The Associate Revenue Cycle Analyst – Billing serves as a subject matter expert and analytical resource within the Clean Claim Team (CCT), focused on ensuring claims are accurately billed, successfully submitted, received, and accepted by payers before entering the downstream denial process.

This role investigates complex front-end billing and claim submission issues, including EDI and clearinghouse rejections, duplicate submissions, authorization-related rejections, provider enrollment issues, payer registration issues, patient demographic errors, and other barriers to clean claim acceptance.

Beyond resolving individual issues, the Associate Revenue Cycle Analyst uses data to identify patterns, determine root causes, assess the broader impact across the claim population, and implement sustainable solutions that prevent future rejections. The successful candidate will combine strong revenue cycle expertise with technical and analytical skills and will independently own complex problems from initial investigation through resolution, testing, implementation, and ongoing performance monitoring.

Job Responsibilities

• Serve as a subject matter expert for clean claim submission and front-end billing processes, with a strong understanding of the claim lifecycle from claim creation through payer receipt and acceptance.
• Analyze claim rejections and operational data to identify trends, recurring issues, root causes, and opportunities to improve clean claim performance.
• Investigate EDI and clearinghouse rejections, duplicate submission issues, incorrect or missing ICN information, prior authorization-related rejections, provider enrollment and NPI registration issues, patient demographic errors, and other claim submission barriers.
• Research rejection reasons, determine the root cause, and provide all of the necessary information, documentation, system corrections, or operational changes to the appropriate cross-functional teams in order to resolve them.
• Evaluate identified issues beyond the individual claim to determine the broader claim population, payer, workflow, or business processes impacted.
• Identify upstream causes of claim rejections and develop sustainable solutions designed to prevent recurrence and reduce downstream denials.
• Use SQL and Snowflake to obtain and analyze claim and operational data, quantify issues, identify affected populations, validate root causes, and measure improvement.
• Utilize advanced Excel functionality, including pivot tables and lookup functions, to analyze large datasets, identify meaningful trends, and create clear and actionable reporting.
• Develop dashboards, reports, automation, tracking tools, and other analytical resources to improve visibility into claim submission and rejection performance.
• Independently manage complex issue resolution and improvement initiatives from initial identification through completion, including coordinating cross-functional work, tracking progress, testing solutions, validating implementation, and monitoring post-implementation results.
• Partner closely with Coding, Insurance Verification, Prior Authorization, provider enrollment, technology, vendor operations, and other teams whose processes impact clean claim submission and acceptance.
• Maintain ownership of cross-functional issues rather than simply escalating or transferring them, ensuring identified problems are followed through to successful resolution.
• Develop and improve workflows and SOPs that increase claim accuracy, operational efficiency, and first-pass payer acceptance.
• Monitor key performance indicators, rejection trends, and operational performance to proactively identify emerging issues and opportunities for improvement.
• Create and present detailed, executive-ready presentations communicating trends, root causes, remediation efforts, project status, and upstream and downstream revenue cycle impacts.
• Translate complex billing and analytical findings into clear recommendations for operational teams and leadership.
• Maintain knowledge of payer requirements, billing rules, EDI processes, and other changes affecting claim submission and acceptance.
• Act as an educator and resource to operational teams regarding identified issues, process improvements, and best practices.
• Proactively identify opportunities to leverage data, technology, automation, and workflow improvements to increase clean claim rates and prevent avoidable rejections and denials.

Qualifications

• Bachelor’s degree in business, healthcare, analytics, or a related field preferred.
• 2–3+ years of experience in medical billing, claims operations, revenue cycle management, insurance collections, or a related healthcare function.
• Strong understanding of healthcare revenue cycle processes and the claim lifecycle, particularly claim creation, submission, clearinghouse processing, payer acceptance, rejection, and denial.
• Experience investigating claim rejections, EDI transactions, clearinghouse issues, payer requirements, provider enrollment, or other front-end billing issues strongly preferred.
• Working knowledge of medical billing and coding concepts, including CPT/HCPCS, ICD-10, modifiers, authorization requirements, payer requirements, and claim identifiers.
• Proficiency with Microsoft Excel, including pivot tables, lookup functions, data manipulation, and analysis of large datasets.
• Working knowledge of SQL and experience using a data warehouse or analytics platform such as Snowflake. Candidates should be able to independently obtain the data needed to answer business questions using SQL, including effectively leveraging AI-assisted query development when appropriate.
• Demonstrated ability to analyze data, recognize patterns, investigate root causes, and translate findings into actionable operational solutions.
• Strong project management and organizational skills with demonstrated ability to independently drive initiatives from problem identification through implementation and post-implementation monitoring.
• Strong written and verbal communication skills, including the ability to create polished presentations and communicate detailed findings to leadership.
• Ability to work autonomously, follow complex issues through multiple systems or teams, and proactively determine appropriate next steps.
• Strong critical-thinking, problem-solving, and solution-oriented mindset.
• Ability to quickly learn new revenue cycle processes, systems, technologies, and payer requirements.