Revenue Cycle Specialist I

Responsibilities

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines
• Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims
• Identifying errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners
• Performing contract and reimbursement variance analysis
• Analyzing claims data to identify contractual overpayments and billing errors
• Aiding department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources
• Learns or remains current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing
• Providing subject matter expertise on billing and coding guidelines and regulations as required by the department
• Using internal and external billing protocols and regulations for repricing bills at a cost savings to the customer
• Identifying trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing
• Establishing and maintaining detailed knowledge and documentation of all analysis/data sources within the department
• Analyzing all forms of Revenue Cycle transactions
• Running standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders
• Producing daily, monthly and annual evaluations and statistical reports, analyzing drivers of variances over time to ensure the integrity and accuracy of revenue cycle data
• Evaluating integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances
• Ensuring strict confidentiality of all medical records, PHI, and PII

Requirements

Claims repricing, pricing configuration, or provider maintenance experience required

3+ years of relevant experience or equivalent combination of education and work experience

High School Diploma or equivalent required

Qualifications

Detailed knowledge of pay reimbursement methodology

Strong understanding of healthcare revenue cycle and claims reimbursement

Knowledge of Microsoft Office products, including Word, PowerPoint, Excel and Outlook, Windows operating system and Internet

Ability to work independently and use critical thinking

Strong analytical and problem-solving skills

Strong attention to detail and ability to deliver results in a fast-paced and dynamic environment

Skills

Knowledge of billing protocols and regulations

Understanding of healthcare revenue cycle and claims reimbursement

Microsoft Office products proficiency (Word, PowerPoint, Excel, Outlook)

Independent work capability and critical thinking

Strong analytical and problem-solving skills

Attention to detail

Benefits

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Accident Insurance

Critical Illness Insurance

Pre-paid Legal Insurance

Parking and Transit FSA accounts

401K

ROTH 401K

paid time off