Supports California operations by analyzing and improving front-end revenue cycle performance across multiple programs. Serves as a subject matter expert in eligibility verification, payer requirements, authorization management, financial clearance, and billing readiness processes. Partners with operational, clinical, billing, and revenue cycle leadership to improve workflows, reduce compliance risk, and drive operational excellence through data-driven decision-making.
Key responsibilities include:
- Analyzing front-end revenue cycle workflows, eligibility verification, financial clearance, and billing readiness
- Interpreting Medi-Cal, Medi-Medi, commercial payer, authorization, Share of Cost, and eligibility requirements
- Developing and maintaining procedures, controls, best practices, KPIs, dashboards, scorecards, and operational reports
- Identifying workflow issues, risks, and root causes, then recommending corrective actions
- Supporting audits, contract compliance, reporting requirements, and operational initiatives
- Delivering training on payer requirements, eligibility processes, financial clearance, and billing readiness standards
- Providing subject matter expertise on EHR and billing platforms such as IRIS, Avatar, or similar systems
- Collaborating across teams to improve processes and support organizational goals
- Participating in county, operational, revenue cycle, and cross-functional meetings as needed
Requirements & Qualifications
Required qualifications
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Analytics, Public Health, or a related field, or equivalent directly related education and experience
- At least 3 years of experience in revenue cycle, billing operations, financial clearance, healthcare operations, payer operations, or related analytical work
- 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 use independent judgment and make recommendations on complex operational issues
Preferred qualifications
- 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 & Perks
Full-time employee benefits
- Paid vacation days, increasing with tenure
- Separate sick leave that rolls over annually
- Paid holidays
- Medical, dental, and vision insurance options
- DailyPay access to earnings before payday
- Training, development, and professional growth opportunities
Additional benefits
- 401(k)
- Employee Assistance Program (EAP)
- Pet insurance
- Perks @ Clarvida discounts on shopping, travel, Verizon, and entertainment
Benefits may vary by state or county.
Location
Anaheim, California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$85,000 - $95,000
Remote work allowed
Yes
Posted
2 months ago