Position Summary
We are seeking a skilled Revenue Cycle Analyst with experience in Real-Time Eligibility (RTE) configuration and insurance coverage workflows. The ideal candidate will support eligibility automation, payer configuration, and coverage management processes to ensure accurate insurance verification and efficient revenue cycle operations.
This role involves system configuration, eligibility transaction management, and collaboration with patient access and billing teams to optimize insurance workflows and reduce claim denials.
Key Responsibilities
Eligibility & Coverage Configuration
• Configure and maintain Real-Time Eligibility (RTE) workflows.
• Implement and support query chaining for payer eligibility verification.
• Configure and maintain Medicare Secondary Payer (MSP) indicators.
• Perform insurance plan mapping and payer configuration.
• Build and maintain auto coverage creation rules from eligibility responses.
• Support term and replace coverage processes based on eligibility results.
• Maintain and update Guarantor Assignment Table rules (preferred).
• Support ID card exchange and coverage discovery workflows.
Revenue Cycle Operations Support
• Support patient access and billing teams with insurance verification processes.
• Ensure accurate capture and maintenance of insurance coverage data.
• Monitor and troubleshoot eligibility transaction errors.
• Improve payer connectivity and eligibility success rates.
• Support claim denial reduction initiatives.
System Configuration & Testing
• Perform system build, testing, and validation of eligibility configurations.
• Analyze payer response data and implement workflow improvements.
• Participate in system upgrades, enhancements, and change management.
• Document system configurations and process changes.
Cross-Functional Collaboration
• Work closely with patient access, billing, and revenue cycle teams.
• Provide technical support for insurance and eligibility issues.
• Support process improvement and workflow automation initiatives.
Compliance & Reporting
• Ensure compliance with payer rules and healthcare regulations.
• Monitor eligibility transaction performance.
• Generate reports and analyze coverage data trends.
Required Qualifications
• Experience in healthcare revenue cycle or eligibility configuration.
• Hands-on experience implementing:
• Query Chaining
• MSP Indicator
• Plan Mapping
• Auto Coverage Creation
• Experience with eligibility response processing and coverage workflows.
• Strong understanding of insurance verification processes.
• Experience with healthcare systems or revenue cycle platforms.
• Strong analytical and problem-solving skills.
Preferred Qualifications
• Experience with Guarantor Assignment Table configuration.
• Experience with term and replace coverage workflows.
• Experience with ID Card Exchange or Coverage Finder tools.
• Experience with Epic Revenue Cycle / Eligibility modules (preferred).
• Knowledge of payer integrations and EDI transactions.
Required Skills
• Revenue cycle operations knowledge
• Insurance eligibility workflows
• System configuration and testing
• Data analysis and reporting
• Process improvement
• Strong communication and documentation skills
Eligibility & Coverage Configuration
• Configure and maintain Real-Time Eligibility (RTE) workflows and insurance verification processes.
• Support ID Card Exchange functionality to enable automated retrieval and validation of patient insurance information from payer systems.
• Configure and maintain Coverage Finder tools to identify and verify active patient insurance coverage through payer platforms.
• Implement query chaining for payer eligibility verification.
• Configure MSP (Medicare Secondary Payer) indicators and insurance plan mapping.
• Build and maintain auto coverage creation rules based on eligibility responses.
• Support term and replace coverage workflows and coverage lifecycle management.