Revenue Cycle Specialist One

Overview

Be inspired. Be valued. Belong.  At Emory Healthcare 

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide:  

•  Comprehensive health benefits that start day 1  

• Student Loan Repayment Assistance & Reimbursement Programs  

• Family-focused benefits  

• Wellness incentives 

• Ongoing mentorship, development, leadership programs 

• And more 

Description

JOB DESCRIPTION:

 

• Versatile in all aspects of the Revenue Cycle through Resolution of all patient claims.
• This position updates demographic and insurance information for accuracy on all patients.
• Collects and follows up on all accounts assigned prior to, during or after admission and discharge.
• Communicates EHC's financial policies to all patients.
• Identifies patients who require financial counseling intervention; provides information regarding resources for patients who need financial help after discharge and/or during collections and follow up activities.
• Verifies, researches and completes all paperwork and forms to bill all types of claims for reimbursement. Serves as a patient advocate during the cycle of the account.
• Assist with departmental workflow as needed.
• Identifies and notifies leadership of issues and initiates appropriate action for resolution.
• Serves as point person for employee questions.
• Maintains thorough understanding of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure reimbursement of claims.
• Provides support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials through the quality assurance process.
• Assists in training and development of new staff members.
• Must be able to review and operationalize contracts as it relates to billing and reimbursement of complex claims.
• The position may be responsible for understanding and maintaining knowledge of standard for care of specific transplant population and the phases of donors and recipients.
• Provides liaison and educational services in support of standards.
• Identifies and resolves financial issues relating to all patients.
• Problem solving skills are required as the applicant must be able to use various tools, analyze the situation, research data and resolve and/or formulate a decision.
• Works closely with Management in formulating and implementing departmental objectives toward enhancing the work flow of the department.
• This position requires heavy phone and computer usage, and a detailed knowledge of applicable EMRs, patient accounts, payer, and financial tools.
• Additionally, education sessions and insurance payor forums should be attended as appropriate.
• Specialist is required to review, analyze and understand the Managed Care Contracts and various aspects of patient care to maximize reimbursement.
• This includes but is not limited to transplants, hospice, infusions, rehab and Center of Excellence patients.
• Knowledge of payer requirements including pre-cert requirements, splitting of claims, analyzing payments, researching complex payment variances are critical for patient and/or account resolutions.
• The Revenue Cycle Specialist must be able to work independently.
• They must have excellent verbal, written, analytical and interpersonal communication skills. Professionalism must be maintained at all times regardless of circumstances.
• Organization skills are also very important.
• Other job duties as assigned pertinent to the Revenue Cycle.
• Performs other duties as required.

 

 

MINIMUM QUALIFICATIONS:

• Bachelors Degree with two years of relevant experience; OR any combination of equivalent education and experience.

 

 

PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

 

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

 

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at [email protected]. Please note that one week's advance notice is preferred.