Revenue Cycle Analyst

OCES is growing! We are expanding to 11 more towns covering the south shore area, including Quincy, Braintree, Weymouth, etc. APPLY NOW during this exciting time!

OCES supports older adults and individuals with disabilities by providing vital information and coordination of services. By promoting healthy, safe living for our consumers, we hope to allow them to stay active and engaged in their lives and in their own communities for as long as possible.

Our mission: Through the talents of an experienced and diverse workforce, OCES supports the independence and dignity of older adults and individuals with disabilities by providing essential information and services that promote healthy, safe living which positively impacts our community.

We are seeking a Revenue Cycle Analyst to ensure the transactional integrity and precision of the organization's revenue streams by executing advanced claims analysis, resolving complex billing discrepancies, and optimizing private pay and managed care payment captures.

What you'll do:

• Steward the granular validation, coding accuracy, and submission lifecycle of complex billing streams to ensure technical compliance.


• Execute forensic, deep-dive audits of unpaid, partial, or rejected claims to isolate technical errors, coordinating immediate corrective action to capture lost revenue.


• Manage technical dispute resolution by functioning as the primary operational link between Senior Care Options (SCO) and One Care plans (OCP), and internal stakeholders.


• Optimize the mechanisms for tracking, invoicing, and capturing SCO and OCP fee balances, mitigating bad-debt risk through systematic and empathetic follow-up


• Continuously audit electronic data interchange (EDI) logs and member demographic flows to proactively eliminate recursive matching errors between billing networks


• Other duties as needed.

Key Performance Indicators:

• KPI: Percentage of claims successfully passed and adjudicated on the initial submission pass.


• KPI: Average number of business days taken to successfully resolve a flagged claim discrepancy or dispute.


• KPI: Days Sales Outstanding (DSO) minimization across SCO and OCP.

What you'll bring:

• Strong analytical and critical thinking skills


• Excellent organizational skills and attention to detail


• Experience with federal and state contracts


• Proficient with Microsoft 365 and related software


• A minimum of Five years of experience

What you'll get:

• The ability to work with an enthusiastic team of like-minded individuals.


• Opportunity to develop professionally in your chosen career.


• Great work/life balance: 35-hour work week with some flexibility; standard M-F work week; hybrid work environment

APPLY TODAY!

OCES is an open, welcoming organization that respects our diversity. We encourage all qualified people to apply!