Revenue Cycle Operations Specialist - GI

Brown Health Medical Group•East Providence, RI

10d•Onsite

About The Position

The Revenue Cycle Operations Specialist serves as the primary operational lead and subject matter expert for revenue cycle performance within assigned clinical departments, service lines, and ambulatory practices. Reporting to operational leadership, this position partners closely with physicians, advanced practice providers, Finance, Coding, Revenue Integrity, Patient Financial Services, Managed Care, Compliance, Information Systems, and other stakeholders to optimize revenue cycle performance and support financial sustainability. The position is accountable for identifying opportunities to improve revenue capture, reduce denials, enhance reimbursement, strengthen operational workflows, and mitigate revenue leakage.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, Accounting, or related field required.
Equivalent combination of education and experience may be considered.
Minimum five (5) years of experience in healthcare revenue cycle, physician practice operations, healthcare finance, reimbursement, revenue integrity, or related healthcare operations.
Experience with Epic strongly preferred.

Nice To Haves

Experience in an academic medical center, integrated health system, or large physician group.
Knowledge of CPT, ICD-10, reimbursement methodologies, and revenue integrity principles.
CRCR, CPC, CPMA, CHRI, HFMA, or similar certification preferred.

Responsibilities

Serve as the primary departmental resource for revenue cycle operations and performance.
Provide ongoing monitoring and oversight of revenue cycle metrics and operational workflows.
Collaborate with operational leadership, providers, Finance, Coding, Revenue Integrity, and Patient Financial Services to address issues impacting reimbursement and revenue cycle performance.
Identify operational risks, process failures, and performance gaps affecting revenue capture and reimbursement.
Maintain accountability for issue resolution and follow-through across multiple stakeholders.
Monitor professional charge capture performance across clinical, procedural, and ambulatory services.
Reconcile clinical activity, scheduling activity, procedural volumes, and billing activity to identify missed or delayed charges.
Investigate charge capture discrepancies and coordinate resolution with providers, coding teams, practice operations, and revenue integrity personnel.
Monitor charge lag reports and identify trends requiring operational intervention.
Support implementation of charge capture workflows for new providers, services, programs, and practice locations.
Monitor denial trends by provider, payer, location, service line, procedure, and denial category.
Conduct root cause analysis of recurring denial patterns and reimbursement variances.
Collaborate with coding, authorization, contracting, and revenue cycle teams to implement corrective actions.
Support initiatives designed to improve first-pass claim acceptance and reduce preventable denials.
Develop, maintain, and analyze revenue cycle reports, dashboards, and performance metrics.
Monitor charge lag, missing charges, denial rates, reimbursement trends, AR performance, write-offs and revenue leakage indicators.
Prepare routine and ad hoc reports for department leadership and executive management.
Present findings and recommendations to operational and physician leadership.
Serve as the primary revenue cycle liaison to physicians and advanced practice providers.
Identify recurring documentation issues affecting coding accuracy and reimbursement performance.
Coordinate provider education efforts in partnership with Coding, Compliance, and Revenue Integrity teams.
Promote provider accountability for timely documentation and charge submission practices.
Evaluate workflows affecting billing, reimbursement, charge capture, and denial performance.
Participate in Epic optimization initiatives and system enhancement projects.
Assist with workflow redesign, testing, implementation planning, and operational adoption of system enhancements.
Establish partnerships with operational leaders, physicians, Finance, Revenue Integrity, Coding, Compliance, Information Systems, Managed Care, and Patient Financial Services teams.
Serve as a departmental subject matter expert on revenue cycle operations and reimbursement-related workflows.
Lead and support revenue cycle improvement initiatives and operational performance projects.
Support implementation of enterprise revenue cycle initiatives, process standardization efforts, and strategic projects.