Manage day-to-day revenue cycle operations for lab services including denials management, appeals, self-pay inventory, claims write-offs, client edits, payer policy changes, AR aging, eligibility and insurance discovery. Oversee and report denials/appeals activity, guide team to meet AR and collection goals, identify payment trends and process improvements, ensure regulatory and policy compliance, and support recruitment, training and workload allocation.
Pacific Diagnostic Laboratories seeks a PDL Revenue Operations Analyst for their Administration department responsible for the overall day-to-day operations of denials management, appeals, self-pay inventory, claims write-offs, client edits, client portal usage, payer policy changes, AR aging across all payer classes, insurance eligibility and insurance discovery trends. Actively oversees, maintains, and communicates denials and appeals activity to clients and internal stakeholders. Provides guidance and direction to the team to ensure the department maintains or exceeds goals including total AR collections, credit balances, # of and amount of edits and denials, identifies emerging trends in claims payments and assesses expected vs actual reimbursement. Ensures all activities are performed in compliance with Cottage Health (CH) and PDL policies, procedures, and Federal and State regulations. Assists in recruitment, retention, training and work allocation.
QUALIFICATIONS:
All job qualifications listed indicate the minimum level necessary to perform this job proficiently.
Education:
- Required: Bachelor's degree or equivalent Lab RCM work experience of 6 years.
Technical Requirements:
- Required: Must be able to demonstrate an understanding of ICD-10 coding for Lab CPT's, working payer denials and appeal processes. Expertise in healthcare insurance eligibility, verification and claims filing procedures. Expertise in utilizing software applications to maximize automation and efficiency in a business office setting. Proficient in Microsoft Office suite, with an emphasis on Excel and PowerPoint. Able to analyze data to identify trends and opportunities for process improvement.
- Preferred: MS-Office 365.
Years of Related Work Experience:
- Required: Five years LAB RCM experience, preferably in a multi-facility environment including three (3) years of progressive responsibility in healthcare revenue cycle. Experience working with legal consent policy and procedures and payer contracting and policies. Knowledge of medical terminology.
- Preferred: Minimum if five (5) years related work experience.
Cottage Health is a leading acute care hospital system, located on the central coast of California, widely known for our superior patient care, innovation, medical research and education. Our health system operates primarily in Santa Barbara, CA, since 1888, and consists of three acute care hospitals, a Rehabilitation Hospital, multiple clinics and a multi-site Urgent Care system. Our mission is to serve the central coast communities with excellence, integrity, and compassion. Every day we touch thousands of lives in many different ways, resolute in our mission to put patients first. We take pride in helping our patients get back to living their lives - in the places they love.
*Pay for non-physician positions is determined based on related years of experience and internal equity. Eligible employees may also receive additional forms of compensation, including shift differentials, on-call pay, incentive pay, and bonus opportunities, where applicable. Manager and above positions may participate in Cottage Health’s annual management incentive program. Physician compensation is determined based upon specialty and may include bonus potential. For more information on our comprehensive Total Rewards offerings, please visit https://cottagehealth.org/careers/total-rewards.
If you're already a Cottage Health employee, please apply on this link only.
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