Revenue Cycle Analyst, Regulatory & Specialty Services - Pathology (REMOTE)
About the position Supports and advances revenue cycle performance for Weill Cornell Medicine. This role applies deep knowledge of medical specialties coding, billing workflows, laboratory reimbursement rules, and payer coverage policies to improve financial outcomes and ensure compliant, accurate, and optimized revenue capture across specialty and multi-specialty practices. The analyst partners closely with department leadership, laboratory operations, coding teams, faculty, and central revenue cycle functions to identify opportunities, resolve revenue cycle barriers, and drive sustainable improvement.
Responsibilities
- Manages clinical practice's expectations regarding financial performance. Research issues and presents findings to administrators for process improvement.
- Reviews ordering patterns, charge capture accuracy, and test-specific reimbursement behaviors to identify underpayments, denials, and missed billing opportunities.
- Conducts analysis of revenue trends, including professional and technical components, CPT/HCPCS code utilization, add-on services (e.g., special stains, IHC, molecular tests), and laboratory panels.
- Monitors changes to CMS and commercial payer coverage policies specific to department testing (e.g., NCDs/LCDs, molecular diagnostic requirements, medically necessary criteria, bundling edits).
- Advanced knowledge of CPT coding, including laboratory (80000 series), Molecular Tier 1 & 2, (IHC), surgical pathology levels (88300–88309), interpretation services, special stains, flow cytometry, and ancillary diagnostic testing.
- Collaborates with Physician Organization Managed Care Office to initiate and manage Payer reimbursement disputes to resolution.
- Leverages EPIC Beaker/CPOM and HB/PB workflows to identify issues related to result routing, order linkage, charge capture timing, and missing professional versus technical splits.
- Monitors performance to ensure financial and departmental posting benchmarks are maintained.
- Analyzes denials (e.g., bundled NCCI edits, missing/invalid diagnosis, lack of prior auth on molecular/genetic testing, frequency limitations, modifier usage). Performs other duties as assigned.
Requirements
- Bachelor’s degree in health administration, laboratory sciences, business, analytics, or related field preferred. Equivalent experience may be considered.
- Medical Coding Knowledge (CPC preferred)
- Approximately 3 years of analytical related experience in physician billing or practice management, preferably in an academic medical center.
- Experience working with laboratory information system LIS (EPIC Beaker strongly preferred).
- Proficiency with EPIC reporting, Power BI, Cognos, SQL-based tools, or similar analytics platforms.
- Excellent oral and written communication skills, with the ability to explain complex reimbursement rules to department leadership, clinicians, laboratory teams, and front-end staff with clarity and precision.
- High proficiency with Microsoft Excel (pivot tables, v-lookups, data modeling).
- Strong multitasking, problem-solving, and organizational skills.
- Ability to work independently while contributing to a collaborative, team-oriented environment. Nice-to-haves
- Proven comfort operating as a primary subject matter resource for complex services, requiring sound judgment in the absence of peer specialization or automation.
- Direct experience with diagnostic testing or laboratory professional services requiring nuanced CPT selection, modifier usage, and documentation review.
- Knowledge of component-based billing models, split billing arrangements, and payer-specific reimbursement methodologies.
- Demonstrated ability to independently interpret and apply payer medical policies, including navigating inconsistent or non-standard coverage determinations.
- CPC preferred.
- Additional specialty-certification related to department or laboratory coding (e.g., molecular coding certificate) is a plus. Apply tot his job
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