RCM Workflow Analyst

About CLS Health :

At CLS Health, we are redefining healthcare delivery. As Houston's largest physician-owned, physician-led healthcare system, our mission is to provide patient-centered care through innovation and operational excellence. With over 200 providers in 35+ locations and over 50 specialties, we're building a scalable healthcare system that empowers physicians and delivers unmatched quality and access for patients.

We are Looking for :

We are seeking a detail-oriented and process-driven RCM Workflow Analyst to help map, optimize, and standardize the end-to-end revenue cycle process from patient encounter to claim resolution. The ideal candidate has strong experience in revenue cycle operations, a deep understanding of the claim lifecycle, and familiarity with denial management tools. You'll play a key role in developing scalable SOPs, supporting exception handling logic, and partnering with stakeholders to ensure that automation opportunities are effectively implemented.

Key Responsibilities :

• Map and document the full claim lifecycle, from patient encounter through coding, billing, edits, denials, appeals, and resolution.
• Identify process inefficiencies and recommend automation opportunities, including rule-based logic for exceptions, holds, and audits.
• Develop and maintain standard operating procedures (SOPs) for :
• Claim holds and edits
• Coding and billing audits
• Appeal types and workflows
• Collaborate with RCM, compliance, product, and engineering teams to align business workflows with system capabilities.
• Support development and implementation of automation tools and decision trees (e.g., Coder+ workflow engine).
• Analyze trends in denials and exceptions to guide continuous process improvement.
• Assist in UAT and workflow validation during system changes or product deployments.

Why You'll Love Working With Us :

Full benefits package including :

Requirements

Preferred Qualifications :