Employment Type:

Full time

Shift:

Day Shift

Description:

Position Purpose:

The Revenue Cycle Specialist is responsible for performing daily revenue cycle activities and functions, focusing on denial management and pre-service authorization functions.

What you will do:

• Responsible for performing department daily revenue cycle activities.

• Understands department specific charge sets and can utilize systems to ensure appropriate CPT and ICD-10 codes were utilized.

• Reconciles daily schedules and performs review of charge capture for accuracy and appropriateness.

• Reviews department denials and write-off reports and is directly involved in the appeal processes.

• Investigates and addresses over-payments and underpayments with the objective of appropriately maximizing reimbursement based on services delivered and ensuring the claim is settled in a timely manner.

• Performs pre-service check processes, including pre-authorization and medical necessity review as indicated.

• Applies knowledge of specific payer payment rules to ensure timely claim resolutions.

• Proactively follows up on payment delays and/or variances by contacting 3rd party payers and supplying additional information, as necessary.

• Reviews, provides, and submits additional information, including medical necessity and documentation for appeals, as necessary.

• Ensures compliance with federal, state, and payor regulatory requirements.

Hours/Schedule:

• Full Time/Days

Minimum Qualifications:

Education:

• High school diploma or equivalent; knowledge of medical terminology is preferred.

• Associate degree in finance, accounting, business administration, or related field, preferred.

Experience:

• Two years or more experience within a hospital or clinic environment performing prior-authorizations and denial management, preferred.

• Knowledge of insurance and governmental programs, regulations, and billing processes, preferred.

Special Skills and Competencies:

• Typing speed of 35 words per minute (verified by testing) preferred.

• Ability to maintain a high degree of confidentiality.

• Ability to perform multiple tasks simultaneously.

• Demonstrates strong interpersonal skills, ability to interact diplomatically and to maintain a professional demeanor with physicians, the public and hospital staff at all times.

• Ability to discuss personal and financial matters with patients and families.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.