Sr. Revenue Cycle Analyst
ProgenyHealth, LLC
full-time
Posted on:
Location Type: Hybrid
Location: Plymouth Meeting • Pennsylvania • United States
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Job Level
About the role
- The Revenue Cycle Analyst supports payment integrity programs for health plan clients
- Managing the downstream financial and operational activities that occur after claim audit or validation
- Tracking audited claims through recovery, adjustment, invoicing, and reporting processes to ensure identified savings are accurately realized, reconciled, and communicated
- Manage post-audit claim inventory across multiple clients, products, and workflows (pre-pay, post-pay, Pre-ProgenyHealth NICU Claims Review)
- Track claims from audit determination through recovery, adjustment, offset, or denial resolution
- Reconcile client-reported recoveries, offsets, and adjustments to auditor findings
- Identify and resolve discrepancies where recoveries do not directly align to original audit findings
- Support recovery calculations when savings are not explicitly reported and must be derived from claims data
- Coordinate the generation and tracking of audit determination letters, overpayment notifications, and related correspondence
- Maintain letter trackers to support timing requirements, regulatory compliance, and client workflows
- Respond to client inquiries related to recovered amounts, claim status, and financial outcomes
- Prepare pre-invoice and invoice support documentation based on recovered or adjusted claim values
- Partner with Finance to validate invoicing accuracy and timing
- Support revenue recognition by ensuring recoveries meet contractual and audit criteria
- Reconcile invoice totals to claim-level recovery detail
- Produce recurring and ad hoc reports on recovery performance, inventory status, and financial outcomes
- Maintain accurate claim-level documentation to support audits, appeals, reconsiderations, and client reporting
- Track claim iterations, adjustments, reversals, and reconsiderations across multiple data feeds
- Identify workflow gaps, data issues, or process inefficiencies impacting recovery realization
- Collaborate with Audit, Coding, Clinical, Client Success, and Product teams to improve revenue cycle workflows
- Participate in quality assurance reviews to ensure consistency, accuracy, and compliance
Requirements
- 3+ years of experience in healthcare revenue cycle, payment integrity, claims operations, or recovery analytics
- Strong understanding of post-pay and pre-payment claims review workflows
- Experience working with health plans, TPAs, or healthcare vendors (payer-side experience preferred)
- Proficiency analyzing medical claims data, adjustments, offsets, and recovery files
- Advanced Excel skills; ability to reconcile complex datasets
- Strong analytical, organizational, and problem-solving skills
- Excellent written and verbal communication skills.
- Experience supporting payment integrity, audit, or overpayment recovery programs (preferred)
- Familiarity with DRG, inpatient, and high-dollar claim review concepts (preferred)
- Knowledge of payer regulations and audit requirements (e.g., Medicare, Medicaid, commercial plans) (preferred)
- Experience working in multi-client vendor environments with varied workflows (preferred)
- Exposure to appeals, reconsiderations, or provider dispute processes (preferred)
Benefits
- Paid Time Off
- Paid Parental Leave
- Medical, dental, vision benefits
- 401K with company match
- Short- and Long-Term Disability
- Group Life Insurance
- Tuition reimbursement
- Casual work environment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare revenue cyclepayment integrityclaims operationsrecovery analyticsmedical claims data analysisExcelreconciliationauditoverpayment recoveryDRG
Soft Skills
analytical skillsorganizational skillsproblem-solving skillswritten communicationverbal communication