RCM Systems Analyst

Who we are: 

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.

What you’ll do: 

The Systems Analyst is responsible for the execution, maintenance, and support of system configurations, payer setups, and claim processing functions to ensure accurate and efficient revenue cycle operations.

This role focuses on system execution, issue resolution, and data support, ensuring that system functionality aligns with defined workflows and operational requirements.

Responsibilities/Duties:

Claims Rules, Edits & Clearinghouse Support

• Build and maintain claim edits and system rules as directed
• Monitor and resolve clearinghouse rejections and submission issues
• Ensure required claim attachments and payer-specific requirements are met
• Identify recurring issues and escalate patterns for further review

Payer Configuration & Maintenance

• Maintain payer records, billing configurations, and system setup
• Load and update fee schedules and reimbursement tables
• Validate payer setup accuracy and resolve configuration related issues
• Support investigation of payment discrepancies tied to system setup

Reporting & Data Support

• Run and maintain standard operational and financial reports as directed   
• Validate data accuracy and identify discrepancies
• Support reporting requests from RCM leadership and operational teams
• Assist in maintaining consistency of report outputs

Issue Resolution & Troubleshooting

• Investigate and resolve system and claim related issues
• Perform initial issue analysis and document findings
• Escalate complex or high impact issues to senior resources
• Track and monitor issue resolution through completion

Vendor & External Coordination

• Submit and manage tickets with vendors, clearinghouses, and IT teams
• Follow up on open issues to ensure timely resolution
• Maintain payer portal access and support related activities
• Coordinate resolution of system-related issues with external partners

Testing & Change Support

• Execute test scenarios for system updates and configuration changes
• Validate outcomes against expected results
• Document testing results and report issues identified
• Support implementation of approved system changes

Work Queue & Request Management

• Manage intake and tracking of system related requests
• Prioritize tasks based on defined guidelines
• Provide status updates to stakeholders
• Maintain organized tracking of requests and resolutions

System Administration Support

• Support user access requests and account maintenance
• Perform routine system updates and data maintenance
• Assist with system configuration updates as directed
• Maintain system documentation and reference materials

Who you are:

Required Qualifications

• 3–5+ years of experience in revenue cycle operations or healthcare systems support
• Experience with practice management systems (e.g., athenahealth, ModMed, or similar)
• Understanding of:
  • Claims processing lifecycle
  • Basic payer requirements
  • Billing and reimbursement workflows
• Strong organizational and problem-solving skills
• Proficiency in Excel and reporting tools
• Experience with clearinghouse and claim submission processes
• Familiarity with systems like ModMed or athenahealth

What we offer: 

• Excellent growth and advancement opportunities 
• Dynamic environment 
• Access to a diverse network of practitioners 
• Broad infrastructure of tools and programs to enhance the employee experience    
• Competitive Compensation 
• Generous PTO  
• Benefits package: health, dental, vision, 401(k), etc. 

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).  

The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type of years and experience within the industry, education, etc.