Job Details

This position will be hybrid and will require some on site work. Applicant must reside within a 2-hour radius of our home office in Binghamton NY. No relocation, provided.

Applicants must be authorized to work for any employer in the U.S. Care Compass is unable to sponsor employment visas for this role.

The responsibilities of the Revenue Cycle Billing & Analyst, Specialist include the following:

Essential Functions:

• Lead daily production workflows, worklists, and escalation management for claims creation, submission, reconciliation, and cash posting.
• Monitor and manage accounts receivable performance, ensuring timely follow-up, resolution, and payment posting.
• Liaise with payers and Managed Care Organizations (MCOs) to resolve systemic claims issues and drive process improvements.
• Drive root-cause analysis for top denial categories and implement prevention strategies.
• Develop, document, and maintain denial management playbooks, workflows, and training materials.
• Establish quality checks, audits, and controls to ensure accuracy and compliance across claims processes.
• Own end-to-end credentialing and payer enrollment processes, including CAQH maintenance, Medicaid and MCO rosters, taxonomy and NPI alignment, EFT/ERA setup, and clearinghouse connectivity.
• Ensure enrollment data accuracy to support clean claim submission and payment.
• Partner with Behavioral Health Hub leadership to ensure accurate service mapping, including LCSW scope of practice, CHW services, documentation standards, and encounter-to-claim integrity.
• Coordinate Business Solutions client assessments by collecting operational data, executing maturity scorecards, presenting findings, and implementing corrective actions.
• Maintain standard operating procedures (SOPs), audit documentation, and compliance artifacts aligned with regulatory and payer requirements.
• Support internal and external audits as needed.
• Build, maintain, and enhance Power BI dashboards and SQL queries/views to track first-pass yield (FPY), denial trends, A/R aging, and appeal outcomes.
• Explore and analyze data to uncover performance gaps, operational risks, and revenue optimization opportunities.
• Present insights and recommendations to leadership to support strategic and operational decision-making.

Non-Essential Functions:

May assume additional responsibilities as requested.

MINIMUM REQUIREMENTS:

• Associate's degree in healthcare administration, Business, or related field (Bachelor's degree, preferred).
• Minimum 5-7 years end-to-end Revenue Cycle Management experience (Medicaid/MCO and behavioral health, preferred).
• NYS Medicaid and Managed Care Organization experience
• Knowledge of credentialing, enrollment, and managed care processes.
• Ability to perform root-cause analysis and translate findings into actionable improvements.
• Strong investigative skills: able to interpret EOBs/835s and reconcile to 837s
• Excellent communication, facilitation, and stakeholder engagement abilities.
• Experience with Power BI, SQL, and data analytics for operational reporting.
• Strong organizational skills and ability to work independently.

LICENSE/CERTIFICATION:

• CPC/CPMA or equivalent, preferred

STAFF SUPERVISED:

• None

WORK ENVIRONMENT:

Care Compass Network utilizes a hybrid work model where employees are able to work remotely from a home office or from the CCN office, a non-clinical professional office setting. There may be some travel required for partner and/or network meetings.