Revenue Cycle Specialist

About the role

Join St. Francis–Emory Healthcare, a 376-bed community-connected hospital in Columbus, GA, that blends cutting-edge care with hometown purpose. As part of the ScionHealth network, St. Francis has been recognized with multiple high-performing honors by U.S. News & World Report, disease-specific certifications from the Joint Commission, and was rated a Top Large Hospital in Georgia. The hospital delivers advanced heart, orthopedic, and women’s care services. At St. Francis, you will experience a culture of excellence where your work directly shapes the health of our community.

Responsibilities

• Assist in resolving billing edits that hold patient claims from billing by reviewing medical records and other applicable documentation.
• Improve the accuracy, integrity, and quality of patient charges and ensure minimal variation in charging practices.
• Coordinate all retrospective, concurrent, patient complaint, and external billing audits.
• Exhibit critical thinking skills, decisive judgment, and the ability to work with minimal supervision in a stressful environment.
• Demonstrate working knowledge of precertification and authorizations.
• Edit claims for errors and communicate corrections via eRequest to Parallon.
• Balance, reconcile, and approve the daily deposit for Parallon.
• Explain charges and answer questions concerning patient accounts.
• Interact positively and professionally with patients, customers, and co-workers.
• Ensure the Charge Batch Report is worked and any rejects are corrected in a timely manner.
• Analyze and resolve patient claims held by billing edits (e.g., Bill 45, Bill 49, CRT Medical Necessity, Correct Coding Initiative, Outpatient Code Editor, Inpatient Code Editor, Self-Administered).
• Interact with ancillary departments to obtain additional information needed to properly bill accounts based on medical record documentation.
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve them; notify appropriate leadership.
• Serve as a charge master liaison, including regular reviews of CPT codes, Revenue Codes, and monthly standard CDM error reports; communicate with ancillary departments to resolve issues.
• Maintain the Physician Master and Insurance Master files.
• Handle charge error corrections.
• Manage CRNA billing for both hospital BCBS in-state plans and off-site billing company.
• Manage the PLUS report for staff volume.
• Complete all industrial billing and follow-up.
• Assist ancillary departments with the Charge Audit Tool.
• Add Emergency Room Procedure charges.
• Complete Skilled Nursing and Swing bed logs.
• Complete exhibits 3, 4, 5, and 8 in the Standard Monthly Accrual (SMA) tool.
• Balance the Sleep Lab invoice.
• Participate in special projects and play a key role in RAC and audits.
• Maintain appropriate office ethics and behavior, handling conflicts and concerns professionally and utilizing crisis de-escalation skills when needed.
• Complete multiple urgent tasks in a timely and professional manner.
• Serve as a preceptor or educational resource for new personnel, students, etc.
• Respect and honor cultural and religious differences between patients and self.
• Perform SOX Charge Audits.
• Perform other duties as requested.

Requirements

• High School Diploma or equivalent (including education equivalent to completion of secondary school) or demonstrated ability to perform the essential functions of the role (preferred).
• 1+ year of medical coding experience (required).
• Experience with various payer types (required).

Qualifications

• Certified Revenue Integrity Professional Certification (preferred).