Revenue Analyst

The Lead Revenue Analyst functions independently with a full understanding of all components of the revenue cycle and serves as a senior-level, lead worker within the Pediatric and California Children’s Services (CCS) Authorization Unit. The incumbent completes complex projects of diverse scope and/or portions of large projects, while providing day-to-day operational oversight, workflow coordination, and subject-matter expertise in support of complex financial clearance and authorization activities. The role supports a high-volume, high-impact operation responsible for securing treatment authorizations for CCS patient populations across inpatient, NICU, outpatient surgical, and ancillary services, contributing to the management of approximately $30 million in weekly Discharged Not Billed (DNB) accounts across the enterprise and any UCSF facilities. The Pediatric lead will demonstrate knowledge of pediatric authorization requirements for high cost drugs and a variety of services provided with experience navigating diverse insurance plans and coordinating prior authorizations across commercial and government payers, including Medicaid and other public insurance programs.

Under the general direction of the Revenue Cycle Manager and/or Supervisor, the incumbent functions with a high degree of independence and exercises independent judgment in prioritizing, coordinating, and resolving complex authorization issues to sustain a positive financial outcome.  The Pediatric Lead will ensure that routine and elective services are prospectively financially secured within established timelines (e.g., ≥3 days prior to date of service), while proactively managing urgent, high-risk, and escalated cases that may impact patient care or organizational financial performance.

The role provides functional leadership to a team of approximately 10–15+ authorization staff, including workflow distribution, work queue oversight, productivity monitoring, and quality assurance review. The incumbent serves as a primary escalation point and subject matter resource for complex cases, payor issues, and interdepartmental coordination, while supporting staff training, onboarding, coaching, and ongoing skills development in partnership with unit leadership.

The Pediatric Lead will apply advanced knowledge and a comprehensive understanding of revenue cycle operations, government payor guidelines, commercial payer guidelines, and medical necessity criteria to independently secure authorizations, resolve denials, and optimize reimbursement outcomes. This includes reviewing medical documentation, coordinating peer-to-peer reviews, facilitating Letters of Agreement (LOAs), PAFRs, and other financial clearance activities, and collaborating with clinical, administrative, and billing stakeholders to ensure accurate and timely processing.

The position independently manages and contributes to complex projects with diverse scopes and/or to defined portions of larger departmental or enterprise initiatives. The Pediatric Lead plays a key role in monitoring and improving operational performance by analyzing work queue activity, denial trends, and key metrics; identifying opportunities and making recommendations for workflow improvements; and supporting the implementation of process enhancements that improve efficiency, reduce denials, and enhance patient access. The incumbent regularly communicates with management and practice leadership to provide performance updates, escalate issues, and support strategic initiatives.

The Pediatric Lead interacts with a wide range of internal and external stakeholders, including providers, practice managers, payors, and patients, and is responsible for delivering high-quality customer service, independently resolving complex inquiries, and supporting service recovery efforts. The role requires strong analytical, organizational, and communication skills, as well as the ability to exercise sound judgment and manage competing priorities in a fast-paced environment.

This position operates within a patient-centered, mission-driven academic medical center and is expected to consistently demonstrate UCSF PRIDE values—Professionalism, Respect, Integrity, Diversity, and Excellence—while supporting organizational goals related to patient care, access, and financial performance.

Certain terms and conditions of employment for this position, including the rate of pay, benefits, etc., are currently subject to negotiation with the appropriate union.

Responsibilities

The Lead Revenue Analyst functions independently with a full understanding of all components of the revenue cycle and serves as a senior-level, lead worker within the Pediatric and California Children’s Services (CCS) Authorization Unit. The incumbent completes complex projects of diverse scope and/or portions of large projects, while providing day-to-day operational oversight, workflow coordination, and subject-matter expertise in support of complex financial clearance and authorization activities. The role supports a high-volume, high-impact operation responsible for securing treatment authorizations for CCS patient populations across inpatient, NICU, outpatient surgical, and ancillary services, contributing to the management of approximately $30 million in weekly Discharged Not Billed (DNB) accounts across the enterprise and any UCSF facilities. The Pediatric lead will demonstrate knowledge of pediatric authorization requirements for high cost drugs and a variety of services provided with experience navigating diverse insurance plans and coordinating prior authorizations across commercial and government payers, including Medicaid and other public insurance programs.

Under the general direction of the Revenue Cycle Manager and/or Supervisor, the incumbent functions with a high degree of independence and exercises independent judgment in prioritizing, coordinating, and resolving complex authorization issues to sustain a positive financial outcome.  The Pediatric Lead will ensure that routine and elective services are prospectively financially secured within established timelines (e.g., ≥3 days prior to date of service), while proactively managing urgent, high-risk, and escalated cases that may impact patient care or organizational financial performance.

The role provides functional leadership to a team of approximately 10–15+ authorization staff, including workflow distribution, work queue oversight, productivity monitoring, and quality assurance review. The incumbent serves as a primary escalation point and subject matter resource for complex cases, payor issues, and interdepartmental coordination, while supporting staff training, onboarding, coaching, and ongoing skills development in partnership with unit leadership.

The Pediatric Lead will apply advanced knowledge and a comprehensive understanding of revenue cycle operations, government payor guidelines, commercial payer guidelines, and medical necessity criteria to independently secure authorizations, resolve denials, and optimize reimbursement outcomes. This includes reviewing medical documentation, coordinating peer-to-peer reviews, facilitating Letters of Agreement (LOAs), PAFRs, and other financial clearance activities, and collaborating with clinical, administrative, and billing stakeholders to ensure accurate and timely processing.

The position independently manages and contributes to complex projects with diverse scopes and/or to defined portions of larger departmental or enterprise initiatives. The Pediatric Lead plays a key role in monitoring and improving operational performance by analyzing work queue activity, denial trends, and key metrics; identifying opportunities and making recommendations for workflow improvements; and supporting the implementation of process enhancements that improve efficiency, reduce denials, and enhance patient access. The incumbent regularly communicates with management and practice leadership to provide performance updates, escalate issues, and support strategic initiatives.

The Pediatric Lead interacts with a wide range of internal and external stakeholders, including providers, practice managers, payors, and patients, and is responsible for delivering high-quality customer service, independently resolving complex inquiries, and supporting service recovery efforts. The role requires strong analytical, organizational, and communication skills, as well as the ability to exercise sound judgment and manage competing priorities in a fast-paced environment.

This position operates within a patient-centered, mission-driven academic medical center and is expected to consistently demonstrate UCSF PRIDE values—Professionalism, Respect, Integrity, Diversity, and Excellence—while supporting organizational goals related to patient care, access, and financial performance.

Certain terms and conditions of employment for this position, including the rate of pay, benefits, etc., are currently subject to negotiation with the appropriate union.

Qualifications

Requirements:

• High School diploma or GED and seven years of relevant work exp. OR a Bachelor's degree and three (3) or more years of relevant work experience.

• Knowledge of healthcare eligibility and insurance verification processes.

• Understanding of hospital and outpatient clinic registration, referral, authorization, and billing processes.

• Ability to interpret eligibility information and communicate requirements accurately. 

• Strong customer service and interpersonal communication skills.

• Knowledge of compliance with California Children’s Services (CCS)  requirements, hospital policies, HIPAA, and applicable regulatory standards.

• Experience with Medi-Cal and other California public healthcare programs.

• Experience working with pediatric patients and their families.

• Experience with electronic health records and hospital registration or revenue-cycle systems.

• Demonstrates knowledge of pediatric authorization requirements and processes, with experience navigating diverse insurance plans and coordinating prior authorizations across commercial and government payers, including Medicaid and other public insurance programs.

• The ability to work onsite two days a week or when required in Emeryville.