Revenue Cycle Specialist - Business Office

The Revenue Cycle Specialist will work with CLH colleagues and contracted billing agencies regarding the process of collecting and processing of medical claims. This will include timely processing of claims, reimbursement, and assisting in any denied claims.

Duties:

The colleague will be responsible for, but not limited to the following duties:

• Working with the CLH Department Managers and Administration, as well other appropriate colleagues and/or contracted billing vendors to manage the revenue cycle process for CLH, resolving issues in a timely manner
• Approach problem-solving challenges, having strong attention to detail
• Working collaboratively with CLH colleagues and leadership to audit and analyze revenue cycle activities and provide information regarding any discrepancies.
• Routinely evaluating and documenting the revenue capture process for each department and identifying process improvements
• Facilitating the coding and charge master build for all new services
• Conducting routine, or as requested, claims analysis to verify charge master compliance and identify revenue improvements
• Timely monitoring MCR and Medicaid (MCD) web portals, as well as other payor website and newsletters regarding changes impacting charging, coding, and billing
• Reviewing and updating CPT, HCPCS, and revenue codes for individual departments and services
• Preparing and conducting educational services to departments and colleagues pursuant to audit findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes
• Monitoring denials and working with department managers to improve charge capture
• Analyzing and resolving specific billing edits which may require coding based on the chargemaster, which may be delaying claims from processing (this will be in conjunction with any contracted billing organization or CLH management)
• Serving as charge master liaison with CLH Administration and Management to facilitate clinical department education on appropriate charging of CPT codes and revenue codes
• Monitoring work queues to ensure timely processing of accounts, as well a monitoring late charges to properly identify trends and areas for improvement, keeping CLH leadership abreast of findings and recommendations
• Monitoring revenue cycle activities and assist in educating colleagues to ensure conformity to policies/procedures, survey compliance, and quality assurance
• Obtaining ( within 9 months of position acceptance if not already certified), and maintaining CRIP certification
• Serving as a role model to maintain a healthy, collaborate team environment
• Ensuring continual delivery of revenue integrity
• All other duties as assigned

Prerequisites:

• Bachelor’s Degree preferred, or equivalent combination of education and working experience
• Proficient knowledge of revenue cycle processes and hospital/medical billing
• Working knowledge of code data sets, to include, but not limited to CPT, HCPCS, and ICD10
• Working knowledge of NCCI edits, and Medicare (MCR) LCD/NCDs
• Understanding of reimbursement theories for CAH facilities, including, but not limited to managed care, observation, LOS, bill types
• Proficient understanding of medical terminology
• Capacity to interpret managed care contracts, billing guidelines, as well as state and federal regulations (no signature authority)
• Ability to work with and interpret detailed medical record documents, and communicate effectively with physicians, nursing staff, CLH leadership, and other billing personnel (including contracted billing organizations)
• Proficiency in MS Word, Excel, Outlook, and PowerPoint
• Excellent verbal and written communication skills
• Ability to problem solve both independently and in conjunction with other CLH colleagues, having strong attention to detail
• Ability to speak, read, and write the English language