PACE Senior Revenue Cycle Analyst

PACE Senior Revenue Cycle Analyst Valir

PACE LLC

- Oklahoma City, OK 73102 Apply Overview Position Type Full Time Job Shift Day Education Level 4 Year Degree Travel Percentage Negligible Category Accounting Apply About Our Organization About Valir Health Valir Health is building a differentiated, multi-state platform focused on PACE, hospice, and value-based care for aging populations. We are not a traditional provider—and not a passive payer. We operate at the intersection of clinical care delivery, managed care economics, and regulatory rigor . This role is for someone who understands that revenue cycle is not billing—it focuses on operational performance with supported outcomes. Position Summary The Senior Revenue Cycle Analyst is responsible for end-to-end operational performance of the revenue cycle , including: PACE capitation (Medicaid / Medicare) validation and reconciliation Claims and encounter submission (RAPS, EDS, EDI) Billing, collections, and participant liability Accounts receivable and denial management Insurance claims adjudication awareness (payor logic) Eligibility, enrollment, and revenue alignment Financial reporting, controls, and audit readiness This role blends provider-side execution with payer-side intelligence —a critical capability in PACE and value-based care environments. You will partner across Finance, Clinical, Enrollment, Compliance, and Operations to drive cash, eliminate leakage, and build scalable infrastructure. About the Role What You'll Own 1. Revenue Integrity & Cash Performance Own daily execution of revenue cycle operations across claims, billing, collections, and reconciliation. Improve net collections, reduce avoidable write-offs, and accelerate cash conversion. Ensure complete and accurate revenue capture across all service lines and payment models. Monitor end-to-end revenue flow—from enrollment to payment realization. 2. PACE Capitation & Membership Economics Validate monthly Medicaid and Medicare capitation payments. Reconcile eligibility, enrollment, and payment rosters. Manage retroactive adjustments, disenrollments, and payment corrections. Ensure alignment between participant status, encounter data, and financial reporting. 3. Claims, Encounters & Adjudication Excellence Oversee submission and performance of claims, encounters, RAPS, EDS, and clearinghouse transactions. Apply strong understanding of payer adjudication logic to improve acceptance and payment rates. Monitor rejection trends and implement rapid corrective actions. Ensure compliance with CMS and state-specific submission requirements. 4. Denials, AR & Recovery Strategy Lead AR strategy across all payer types and participant liability. Reduce denial rates through root-cause analysis and upstream fixes. Improve Days in AR, underpayment recovery, and appeals success rates. Establish disciplined follow-up and escalation workflows. 5. Full Continuum Reimbursement Understanding Maintain working knowledge across reimbursement methodologies:

IPPS / OPPS / PDPM / LTACH / SNF

/ physician / outpatient / ancillary Understand coding frameworks (ICD-10, CPT, HCPCS) and their financial implications. Connect clinical activity and utilization patterns to revenue outcomes and expense trends. 6. Expense & Utilization Awareness (Differentiator) Analyze trends in claims expense, utilization, and cost drivers. Partner with clinical and operations teams to identify inefficiencies and cost leakage. Translate utilization insights into actionable operational improvements. 7. Reporting, Controls & Audit Readiness Build and maintain KPI dashboards (AR, denials, cash, encounter acceptance, capitation accuracy). Support month-end close, accruals, and financial reconciliation. Ensure audit-ready documentation for CMS, state, and internal reviews. Strengthen internal controls across all revenue workflows. 8. Systems & Process Optimization Optimize EHR, billing systems, clearinghouses, and reporting tools. Improve workflow integration across departments. Drive automation and scalability for multi-state growth. Ideal Candidate Profile You are not just a senior revenue cycle analyst—you are a financial operator with clinical awareness and payer intelligence .

You likely come from:

Humana / CenterWell Optum / UnitedHealth Group InnovAge Alignment Health Large health systems or PE-backed healthcare platforms You understand both: How providers bill How payers pay (and deny) Qualifications Bachelor's degree required; Master's preferred 7-10+ years healthcare revenue cycle experience Experience across both: Claims billing (provider side) Claims adjudication or payer logic (strongly preferred) Strong knowledge of:

ICD-10, CPT, HCPCS EDI

/ clearinghouse workflows Medicare / Medicaid reimbursement Experience with capitation, risk models, or PACE strongly preferred Proven ability to improve KPIs and operational performance Physical Requirements (Subject to Reasonable Accommodation):

Keyboarding/dexterity:

frequently; activity exists up to 75% of the time

Communication:

ability to read, speak, and hear in English.

Strength:

sedentary position (exerting up to 10 lbs of force occasionally)

Standing/Walking:

Occasionally; activity exists up to 25% of the time

Working Conditions:

This position is primarily performed in an indoor, climate-controlled office environment. Occasional travel between Valir Health sites (Oklahoma City, Shawnee, Cherry Blossom) may be required. This role may involve CRT/computer monitor use and frequent repetitive motions associated with keyboard and screen-based work. Remote or hybrid work arrangements may be considered in accordance with Valir Health policy.

Safe Environment:

Demonstrate knowledge of specific and individual role in the fire/safety program including the following management plans: safety, security, hazardous materials/waste, emergency preparedness, life safety, medical equipment and utility systems. Participate in the policies and procedures relating to infection control for self, patients and participants, and staff. Observe proper body mechanics and safety precautions in all job duties. Communicate information about incidents involving self, patients and participants, staff and/or visitors to appropriate parties, using facility incident reporting systems as appropriate. Demonstrates the safe operation of equipment and machinery and follows procedures for reporting and correcting an unsafe situation.

Growth & Development:

Attend and participate in all applicable training and development workshops including mandatory annual in-services/competencies. Actively identify and participate in training, education and developmental activities to improve own knowledge and performance or the knowledge and performance of others. Seek and use feedback to improve own performance. Support Valir Health's culture of learning by sharing insights, tools, and best practices with colleagues across departments. Share job details to