Revenue Cycle Operations Analyst

Summary

Pathways is a leader in behavioral health care, providing community-based mental health and human services. The Revenue Cycle Operations Analyst supports California Operations by analyzing and improving front-end revenue cycle performance across multiple programs, serving as a subject matter expert in various revenue cycle processes.

Responsibilities

• Analyze front-end revenue cycle workflows, eligibility verification processes, financial clearance activities, and billing readiness across multiple programs
• Interpret Medi-Cal, Medi-Medi, commercial payer, authorization, Share of Cost, and eligibility requirements and provide operational guidance
• Develop, implement, and maintain revenue cycle procedures, controls, and best practices that support compliant and efficient operations
• Prioritize revenue cycle issues, identify risks, and coordinate corrective actions with operational and revenue cycle leadership
• Review billing errors, financial clearance trends, and workflow exceptions to identify root causes and improvement opportunities
• Recommend and monitor corrective action plans to improve claim readiness and reduce denial risks
• Develop and maintain key performance indicators (KPIs), dashboards, scorecards, and operational reports
• Analyze operational and financial data to identify trends, forecast risks, and support performance improvement initiatives
• Present findings, recommendations, and action plans to leadership and stakeholders
• Design and deliver training related to payer requirements, eligibility processes, financial clearance, and billing readiness standards
• Provide subject matter expertise on EHR and billing platforms, including IRIS, Avatar, or similar systems
• Collaborate with clinical, operational, billing, and leadership teams to improve workflows and support organizational goals
• Participate in county, operational, revenue cycle, and cross-functional meetings as needed
• Support contract compliance, reporting requirements, audits, and operational initiatives
• Perform additional duties as assigned

Skills

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Analytics, Public Health, or a related field, or an equivalent combination of education and directly related experience
• Minimum three years of revenue cycle, billing operations, financial clearance, healthcare operations, payer operations, or related analytical experience
• Experience interpreting Medi-Cal, Medi-Medi, commercial payer, eligibility, authorization, Share of Cost, and claim readiness requirements
• Experience analyzing operational data and developing reports, dashboards, and performance metrics
• Experience with EHR and billing platforms such as IRIS, Avatar, or similar systems
• Advanced proficiency in Microsoft Excel and reporting tools
• Strong analytical, critical thinking, and problem-solving skills
• Ability to exercise independent judgment and make recommendations regarding complex operational issues
• Experience supporting multiple programs, regions, or business units
• Experience with healthcare KPI reporting, dashboard development, business intelligence, or data visualization tools
• Knowledge of County behavioral health systems, public behavioral health funding structures, and payer contracts
• Experience leading process improvement initiatives, workflow redesign, or cross-functional projects
• CRCR, CHAA, HFMA, Lean Six Sigma, or related certification preferred

Qualifications

Must Haves

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Analytics, Public Health, or a related field, or an equivalent combination of education and directly related experience
• Minimum three years of revenue cycle, billing operations, financial clearance, healthcare operations, payer operations, or related analytical experience
• Experience interpreting Medi-Cal, Medi-Medi, commercial payer, eligibility, authorization, Share of Cost, and claim readiness requirements
• Experience analyzing operational data and developing reports, dashboards, and performance metrics
• Experience with EHR and billing platforms such as IRIS, Avatar, or similar systems
• Advanced proficiency in Microsoft Excel and reporting tools
• Strong analytical, critical thinking, and problem-solving skills
• Ability to exercise independent judgment and make recommendations regarding complex operational issues

Nice to Haves

• Experience supporting multiple programs, regions, or business units
• Experience with healthcare KPI reporting, dashboard development, business intelligence, or data visualization tools
• Knowledge of County behavioral health systems, public behavioral health funding structures, and payer contracts
• Experience leading process improvement initiatives, workflow redesign, or cross-functional projects
• CRCR, CHAA, HFMA, Lean Six Sigma, or related certification preferred

Benefits

• Paid vacation days (increase with tenure)
• Separate sick leave that rolls over annually
• Paid holidays
• Medical, dental, and vision insurance options
• DailyPay – access your earnings without waiting for payday
• Training, development, and professional growth opportunities
• 401(k)
• Employee Assistance Program (EAP)
• Pet insurance
• Perks @ Clarvida – national discounts on shopping, travel, Verizon, and entertainment
• (*Benefits may vary by state or county*)
• Travel required up to approximately 30% for meetings, training, program support, and operational initiatives