Associate Revenue Cycle Analyst - Billing

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.

• 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