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.