Healthcare BA on Revenue Cycle: CDI, Denials, HCC, RAF, and Value-Based Care

Revenue cycle is where healthcare process becomes cash: registration, eligibility, charge capture, CDI, coding (ICD-10 / CPT / HCPCS), claim (837P / 837I), remit (835), denial, appeal. Overlay value-based care — HCC, RAF, HEDIS, STAR — and the Healthcare Business Analyst is the only person who can hold both maps. We pioneered the interview that asks for a denial root cause and a HEDIS numerator in the same hour.

Processes we write, not just name

• Prior authorization and gold-carding under CMS-0057 pressure
• CDI queries that do not become leading and still move CMI / RAF
• Denial taxonomy operations can work — not a 200-reason dump
• HCC recapture as a calendar, not a vendor slide
• ACO / VBC contracts that change what “clean claim” means
• 837I versus 837P as a first-class distinction

We pair the Healthcare BA with an Epic or claims-platform analyst when the story is build, and with a compliance lead when the story is STAR or OCR. Fortune 500 payers and IDNs do not get a lone contractor and a Jira board. They get a cell that already knows 837I versus 837P.

837I is not 837P. RAF is not a dashboard.

Front, middle, back — registration through remit — plus the VBC calendar. CDI queries that lead are a compliance event. Denial taxonomies with 200 reasons are not workable. HCC recapture is a schedule. Prior auth under CMS-0057 is a FHIR workflow, not a fax hope. We write those processes. We UAT on denied accounts. We pair BA + platform + compliance when money and measure collide.

Value-based contracts change what clean claim means. The BA who cannot hold both maps is not the BA. That is the cell.