Job Summary:
The RCM Business Analyst plays a key role in analyzing revenue cycle business needs, identifying opportunities for improvement, and providing actionable insights to drive strategic financial decision-making. This role involves working closely with stakeholders in billing, coding, patient access, and finance to gather and document requirements, analyze RCM data, and develop solutions that enhance revenue cycle processes and financial outcomes. The RCM Business Analyst is instrumental in bridging the gap between business objectives, technology solutions, and revenue integrity across the healthcare revenue cycle.
Essential Duties and Responsibilities:
- Requirements Gathering:Collaborate with RCM stakeholders (billing, coding, patient access, finance) to elicit and document business and regulatory requirements. Conduct interviews and workshops to understand workflows and pain points.
- Data Analysis:Analyze RCM data (claims, denials, payments, A/R aging, etc.) to identify trends, root causes of issues, and opportunities for improvement. Utilize data visualization tools to present actionable insights.
- Process Improvement:Identify inefficiencies in the revenue cycle (patient registration, charge capture, coding, billing, collections) and recommend solutions to improve throughput, accuracy, and cash flow.
- Solution Design:Work with IT and vendors to design, configure, and implement RCM-related systems (EMR, billing software, clearinghouses, etc.). Develop functional specs for system enhancements.
- Project Support:Assist in RCM-related projects such as system implementations, workflow redesign, or compliance initiatives. Help define scope, create documentation, and support execution.
- Testing & Validation:Develop test plans for RCM system changes. Support UAT with end-users and ensure solutions meet business and compliance requirements.
- Reporting:Prepare and present reports on key RCM metrics (clean claim rate, denial rate, days in A/R, collection rate, etc.). Communicate findings to leadership and stakeholders.
- Stakeholder Management:Build strong relationships with RCM teams, clinicians, and IT. Facilitate communication to ensure alignment on goals and successful project outcomes.
- Compliance & Regulatory Awareness:Stay updated on healthcare regulations (HIPAA, CMS guidelines, payer policies) and ensure RCM processes and systems remain compliant.
Education and Required Skills:
- Degree in Software development or related subject.
- 2+ years of experience in revenue cycle management, healthcare billing, or RCM consulting.
- Experience with RCM systems (e.g., Epic, Cerner, Meditech, NextGen) preferred.
- Knowledge of healthcare compliance, coding, and payer policies.
Location : Bangalore India (Initially Remote)
