Revenue Cycle Analyst, Prior Authorizations

The Revenue Cycle Analyst, Prior Authorizations plays a key role in supporting the PA call center and external-facing teams by serving as a subject matter expert on payer policies and prior authorization workflows. This role also focuses on analyzing trends, reporting on call center data, improving processes, managing escalated calls and emails, and supporting cross-functional stakeholders such as providers, patients, sales, billing, and market access teams. This individual will act as a subject matter expert and knowledge resource for all things PA related, and will help ensure the successful navigation of prior authorization (PA) requests and appeals.

• Act as a subject matter expert in prior authorization processes and payer-specific requirements, supporting inquiries from internal and external teams (patients, providers, billing, sales, payers, etc.).
• Analyze escalated issues from calls/emails related to prior authorizations and collaborate cross-functionally to drive resolutions.
• Support call/email-based teams by investigating complex issues, answering escalated questions, and helping improve the end-user experience.
• Conduct trend and root cause analyses related to prior authorization issues and escalate actionable insights to leadership.
• Pull and analyze data from Twilio, Excel, Power BI, and Salesforce to identify opportunities for operational improvement and issue resolution.
• Create and maintain job aids, reference materials, and SOPs related to PA workflows and payer navigation.
• Assist in the design, implementation, and optimization of processes related to authorization submissions, appeals, and vendor-related tasks.
• Collaborate with internal vendor operations teams to ensure authorization and reimbursement-related activities are executed timely and accurately.
• Participate in or lead regular project updates, team check-ins, and stakeholder reviews related to key initiatives and process performance.

• Bachelor’s Degree in a healthcare or business-related field preferred.
• 2–3+ years of experience in medical billing, prior authorizations, and payer interactions.
• Experience working in a billing call center or patient access/healthcare environment is strongly preferred
• Strong familiarity with payer portals and prior authorization requirements across commercial, Medicare, and Medicaid plans.
• Experience in process documentation, job aid creation, and/or internal training preferred.

• Proficiency with medical billing systems, Microsoft Excel, Power BI, and Salesforce.
• Familiarity with Twilio reporting and call/email analytics is a strong plus.
• Working knowledge of CPT/HCPCS, ICD-10, modifier selection, and UB revenue codes.
• Ability to identify and report trends and workflow gaps using data-driven analysis.
• Strong communication skills—capable of distilling technical/operational information to a broad audience.
• Demonstrated critical thinking and problem-solving skills across multi-stakeholder workflows.
• Ability to manage competing priorities and support ongoing project-based initiatives in a cross-functional environment.
• Comfortable working independently while collaborating regularly with teammates and leadership.
• Maintains confidentiality of sensitive information.

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