Revenue Cycle Optimization Specialist

Brault•San Dimas, CA

About The Position

The Revenue Cycle Optimization Specialist is responsible for driving operational excellence across the revenue cycle with a focus on Athena IDX processes, clearinghouse performance, denial prevention, and system optimization. This role applies process improvement initiatives to identify workflow gaps, reduce defects, eliminate waste, and implement sustainable process improvements across Patient Access, EDI, and Accounts Receivable. The Specialist serves as a cross-functional partner to leadership, supporting system configuration, payer mapping, claim logic enhancements, operational projects, and client onboarding and offboarding initiatives to improve revenue cycle KPIs and overall revenue integrity. This position shifts the revenue cycle from reactive denial management to proactive revenue protection. By improving system configuration, standardizing workflows, and preventing defects at the source, the Revenue Cycle Process Improvement Specialist enhances financial performance, operational efficiency, and organizational scalability.

Requirements

Strong working knowledge of Athenahealth systems and healthcare administrative workflows
Exceptional written and verbal communication skills
Strong knowledge of Athena IDX workflows and claim processing logic.
Experience with clearinghouse rejection management and payer mapping.
Analytical mindset with ability to interpret data trends.
Strong cross-functional communication skills.
Ability to work independently with minimal supervision.
Computer keyboarding skills, and experience with MS Office
3–5+ years of Revenue Cycle experience (Registration, EDI, or AR).

Nice To Haves

Knowledge of Lean Six Sigma principles preferred.
Project management and process documentation experience preferred.
Associate Degree, preferred

Responsibilities

Athena IDX Process Optimization
Provide subject matter expertise on workflows within Athena IDX.
Support setup and maintenance of claim logic, system edits, and configuration settings to ensure accurate claim submission.
Support, design, and implement approved claim edits to prevent recurring denials and rejections.
Support approved system enhancements aligned with payer requirements and operational needs.
Clearinghouse Rejection & Denial Prevention
Monitor and identify enterprise-wide rejection and denial trends.
Conduct root cause analysis on denial categories and front-end related defects.
Implement preventive controls to reduce recurring issues.
Track and report improvements in related KPIs.
Insurance & Payer Configuration
Collaborate with Patient Access and EDI team to correct configuration gaps.
Support implementation of new payer setup and electronic connections.
Support ADT payer mapping logic.
Reporting & Data Analysis
Analyze revenue cycle performance reports to identify inefficiencies.
Develop dashboards and metrics to monitor process health.
Measure key indicators including:
Clean claim rate
Rejection rate
Denial rate
Timely resolution of clearinghouse rejections.
Present findings and recommendations to RCM leadership.
Cross-Departmental Collaboration
Partner with Patient Access, EDI, and Accounts Receivable leadership to identify workflow breakdowns.
Facilitate closed-loop feedback between front-end and back-end teams.
Standardize processes to reduce variation and rework.
Support alignment of operational goals across departments.
Operational & Client Lifecycle Support
Assist with onboarding new clients, including: Client Setup in AthenaIDX, Claim logic validation, Insurance configuration
Support client offboarding by ensuring proper system transitions and claim management.
Participate in new operational initiatives and process redesign projects.
Training & Organizational Development
Partner with Corporate Training to identify revenue cycle knowledge gaps.
Provide subject matter expertise for development of targeted education programs.
Support onboarding and refresher training for registration, EDI, and AR teams.
Develop job aids and standardized process documentation.
Operational Excellence & Continuous Improvement
Identify high-impact revenue leakage and workflow gaps.
Track performance metrics and defect rates.
Conduct root cause analysis using data-driven methods.
Implement process controls, system edits, and workflow enhancements.
Monitor outcomes to ensure sustainable improvements.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.