Sr Revenue Cycle Specialist

About the Role

The Senior Revenue Cycle Specialist will act as operational lead in the Revenue Recovery and Retention Unit of Stony Brook Medicine’s hospital business office, analyzing, tracking, and pursuing the payment of Managed Care under-paid and denied accounts receivable.

Responsibilities

• Lead Payer Joint Operating Calls (JOC).
• Analyze payment variances; track and pursue under-paid and denied accounts.
• Liaise with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials.
• Track and trend denials, systemic underpayments, and maintain JOC Trackers.
• Analyze new contracts and work with Contract Management system support to configure contract rates and terms.
• QA all Contract Management system changes including encounter qualifiers and payment rates and methodologies.
• Develop staff work listing logic/strategy and claims resolution workflows.
• Educate new staff regarding Managed Care Contracts, Contract Management System, and Denials and Appeals process.
• Assist in maintaining and creating payer report cards, claims tracking, and management reporting as requested.
• Perform special projects, as assigned.

Requirements

• Bachelor’s degree and three years’ healthcare revenue cycle experience, or in lieu of degree, five or more years of healthcare revenue cycle experience resolving hospital Managed Care payment variances and denials.
• Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies.
• Expert knowledge of third-party reimbursement methodology and associated healthcare claim drivers.
• Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i).
• Experience working with CPT/HCPCs and ICD-10 codes.
• Experience working with Cerner Invision Patient Accounting.
• Proficiency in MS Office Suite, including Excel and Word.
• Excellent written and verbal communication skills.
• Verification of degree (e.g., diploma or official transcript) is required for this role.

Preferred Qualifications

• Experience working within Cerner Contract Management, Epic, or equivalent, including experience validating the configuration and build of contracts.
• Experience building contracts and modeling revenue in a Hospital Contract Management System.
• Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
• Proficiency with MS Access, Visio, and/or PowerPoint.
• Knowledge of SQL or Database Queries.
• Experience reporting from healthcare decision support, patient accounting, contract management, and/or claims scrubber systems.
• Proficiency with SAP Business Objects / Crystal Reports.
• Proficiency with visualization software (Tableau, MS Power BI, etc.).

Special Notes

• This position may remain posted for a maximum of 90 days. An initial review of applicants will occur two weeks from the posting date.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This position may be designated as “essential,” requiring employees to remain at work or report to work during institutional emergencies.
• Prior to the start date, the selected candidate must:
  • Successfully complete a pre-employment physical examination and obtain medical clearance.
  • Complete an electronic reference check with a minimum of three professional references.
  • Successfully complete a 4-panel drug screen.
  • Meet regulatory requirements for pre-employment screenings.
  • Provide a copy of any required New York State license(s)/certificate(s).

Pay

The anticipated salary range for this position is $77,286 - $94,211 per year. The specific salary offer will be based on the candidate’s validated years of comparable experience. Some positions offer annual supplemental pay such as location pay for full-time roles ($4,000).

Schedule

Full-time.