Revenue Cycle Analyst, Regulatory & Specialty Services - Pathology (REMOTE)
Location
United States
Posted
13 days ago
Salary
$106K - $125K / year
No structured requirement data.
Job Description
Title: Revenue Cycle Analyst, Regulatory & Specialty Services - Pathology (REMOTE)
Location: Remote
Org Unit: Engagement and Process Improvement
Work Days: Monday - Friday, 9 AM - 5 PM Eastern Time
Weekly Hours: 35.00
Exemption Status: Exempt
Salary Range: $106,200.00 - $125,000.00
*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices
Position Summary
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.
This is a fully remote position, with the expectation of consistent availability during core business hours of 9:00 a.m. to 5:00 p.m. Eastern Time, to support collaboration with clinical, operational, and administrative stakeholders.
Job 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.
Education
- Bachelor’s degree in health administration, laboratory sciences, business, analytics, or related field preferred. Equivalent experience may be considered.
Experience
- 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).
Preferred Qualifications
- 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.
Knowledge, Skills and Abilities
- 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.
Licenses and Certifications
- CPC preferred.
- Additional specialty-certification related to department or laboratory coding (e.g., molecular coding certificate) is a plus.
Working Conditions/Physical Demands
Cornell welcomes students, faculty, and staff with diverse backgrounds from across the globe to pursue world-class education and career opportunities, to further the founding principle of “any person, any study.” No person shall be denied employment on the basis of any legally protected status or subjected to prohibited discrimination involving, but not limited to, such factors as race, ethnic or national origin, citizenship and immigration status, color, sex, pregnancy or pregnancy-related conditions, age, creed, religion, actual or perceived disability (including persons associated with such a person), arrest and/or conviction record, military or veteran status, sexual orientation, gender expression and/or identity, an individual’s genetic information, domestic violence victim status, familial status, marital status, or any other characteristic protected by applicable federal, state, or local law.
Cornell University embraces diversity in its workforce and seeks job candidates who will contribute to a climate that supports students, faculty, and staff of all identities and backgrounds. We hire based on merit, and encourage people from historically underrepresented and/or marginalized identities to apply. Consistent with federal law, Cornell engages in affirmative action in employment for qualified protected veterans as defined in the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRRA) and qualified individuals with disabilities under Section 503 of the Rehabilitation Act. We also recognize a lawful preference in employment practices for Native Americans living on or near Indian reservations in accordance with applicable law.
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