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Position Overview

The Sr Revenue Operations Analyst -- Insurance Eligibility and Discovery is responsible for overseeing Revenue and Reimbursement collections daily efforts, utilizing actionable data, and preparing detailed analysis. As a partner to the Reimbursement team, this position will deliver ad-hoc and long-term data-driven projects and reporting needs, as well as serve as the reimbursement operations expert for front-end order submission and be focused on driving the efficiency and accuracy of insurance verification processes critical to the organization's reimbursement success. This role requires a deep understanding of healthcare billing and insurance eligibility to not only execute but also innovate within existing workflows. High attention to detail and thorough-investigative abilities are necessary to ensure quality reporting and to deliver data driven decisions. Strong understanding of commercial insurance billing including appeals, denial processes and institutional billing.

Key Responsibilities and Essential Functions

• Ensure daily reimbursement claim processes and billing operations effectiveness.
• Collaborate with reimbursement and finance team, utilizing available technologies and system for analysis to optimize and automate processes.
• Produce effective and actionable metric reporting for all revenue operations related matters.
• Track and investigate trends, performance, and potential issues.
• Lead the end-to-end insurance eligibility and discovery processes for all orders, ensuring the accuracy of insurance data before activation in the lab.
• Partner strategically with Clinical Services, Customer Operations, and the Prior Authorization teams to design and refine workflows that enhance order activation efficiency and compliance.
• Review and interpret data from external eligibility providers to ensure insurance information is precise, actionable, and seamlessly integrated into claims processes.
• Maintain and enhance the organization's billing portal access and functionality, ensuring adaptability for evolving payer requirements.
• Develop and deliver training for internal teams and provide ongoing education on best practices for eligibility verification and insurance compliance.
• Proactively identify opportunities to streamline insurance workflows, leveraging data analytics and cross-functional input to drive efficiency and scalability.
• Collaborate with revenue cycle management teams to mitigate claim errors, reduce denials, and identify trends affecting reimbursement success.
• Work closely with the revenue cycle management teams to verify that insurance information is accurately reflected on claims, minimizing errors and denials.
• Monitor eligibility discrepancies, troubleshoot errors, and resolve insurance information issues promptly, coordinating with internal and external stakeholders as necessary.
• Ensure that all orders meet payer requirements by confirming correct and complete insurance information prior to lab activation.
• Update insurance and eligibility documentation to maintain a record of verification processes and outcomes, supporting internal compliance and audit requirements.
• Participate in training sessions with external data providers to stay updated on best practices for eligibility verification and insurance data handling.
• Identify processes to improve data-influenced decision making and drive efficiencies in business processes.
• Serve as SME for all billing operations and processes.

Position Requirements (Education, Experience, Other)

Required

Bachelors + 5 years of related experience.

Experience with data visualization software and analytics best practices. Experience with Tableau and Tableau Server preferred.

Experience working with business te