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RCM Operations Analyst
Location
Massachusetts
Posted
11 days ago
Salary
$62K - $83K / year
Seniority
Senior
Job Description
RCM Operations Analyst
Cartwheel
• Conduct structured analysis of denial and rejection data to identify root causes, payer patterns, and filing limit exposure • Move beyond rework — trace denial and rejection spikes to upstream workflow, documentation, or submission failures and drive fixes at the source • Build and maintain AR aging trend tracking and recoverable revenue opportunity analysis • Execute claim corrections, resubmissions, and payer follow-up as a hands-on operational contributor • Build and maintain operational dashboards (Looker preferred) that give RCM leadership real-time visibility into denial volume, payer performance, and AR trends • Produce clear, prioritized findings from claim-level data using pivot tables, formulas, and BI tooling • Design reporting outputs so findings are actionable and accessible to non-billing stakeholders — not just data-literate audiences • Translate billing logic, payer-specific rules, and denial patterns into written, maintainable SOPs • Build operational workflow guides prioritized by highest-volume and highest-denial-rate categories first • Ensure documentation is usable by team members without direct guidance, so operational knowledge scales beyond any one person • Partner with clinical teams to identify upstream documentation or workflow gaps contributing to denials and rejections • Validate billing logic and payer requirements in collaboration with RCM leadership • Communicate findings and recommendations in plain language to non-billing stakeholders including clinical and operations partners • Support training and internal knowledge base development as the operational RCM subject matter resource
Job Requirements
- 3+ years of hands-on RCM operations experience with direct responsibility for denial management, rejection analysis, and billing workflow improvement
- Strong analytical skills — ability to extract prioritized, revenue-framed findings from large and complex claim-level datasets
- Experience building or actively maintaining operational dashboards (Looker preferred; comparable BI tools acceptable)
- Proficiency with pivot tables and Excel or Google Sheets for claim data manipulation and analysis
- In-depth knowledge of multiple insurance payer environments — Medicaid MCO experience strongly preferred; commercial payer depth (especially BCBS) also required
- Demonstrated root cause instinct — able to trace denial and rejection patterns to workflow or documentation failures, not just surface-level category identification
- Process improvement mindset with strong cross-functional communication skills and comfort working in a remote, async-first environment
Benefits
- Competitive cash compensation between $62,000 to $83,000
- Equity ownership stake in the company
- High-quality health insurance with a $0 monthly premium option for employees
- Dental, Vision, and Employer-Sponsored Life Insurance
- 4 weeks of paid PTO (3 weeks any time + 1 week office closure in December)
- Sick Leave + Holidays
- 401K with 2% employer match
- Team-based culture with mission-driven colleagues who will go to bat for you
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