Revenue Cycle Operations Specialist II - 40hrs

Connecticut Children's Medical Center•Hartford, CT

15d

About The Position

The Revenue Cycle Operations Specialist II is an experienced role within Revenue Cycle Operations, responsible for performing work in one of two primary functional areas: Mail/Documentation or Credit Balances. In this role, the specialist ensures accuracy, timeliness, and compliance in processing documentation, patient accounts, and financial transactions. This position demonstrates increased proficiency and independence in revenue cycle processes and is expected to support additional operational functions, including Cash Posting, as needed. The Specialist II applies knowledge of systems, workflows, and policies to resolve more complex issues, maintain productivity standards, and contribute to overall departmental effectiveness.

Requirements

High School Diploma or GED or equivalent
Minimum of 3 years of experience in Revenue Cycle Operations or related healthcare financial operations
Working knowledge of healthcare revenue cycle operations, including billing, claims, payments, and account resolution.
Understanding of medical terminology, diagnosis and procedure codes, and reimbursement processes.
Knowledge of document management systems, electronic health records (e.g., Epic), and revenue cycle workflows.
Familiarity with compliance standards, confidentiality requirements, and HIPAA regulations.
Strong proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Effective communication skills for collaborating with internal teams and external stakeholders.
Advanced organizational and time management skills with the ability to manage multiple priorities.
Analytical skills to review account data, identify discrepancies, and resolve issues efficiently.
Problem-solving skills with the ability to independently troubleshoot and escalate appropriately.
Ability to meet productivity and quality standards in a fast-paced environment.
Ability to work independently with limited supervision while maintaining accuracy and attention to detail.
Demonstrates flexibility and adaptability in supporting multiple functional areas, including Cash Posting.
Ability to cross-train and apply knowledge across revenue cycle functions.
Supports team effectiveness by sharing knowledge and assisting less experienced staff.
Maintains confidentiality and exercises sound judgment when handling sensitive patient and financial information.

Nice To Haves

Post-secondary coursework or degree in healthcare, business, or related field
Experience in multiple revenue cycle functions (e.g., documentation, credit balances, cash posting)

Responsibilities

Perform all Documentation Operations responsibilities, including receiving, sorting, scanning, indexing, and distributing incoming and outgoing mail.
Ensure accuracy, timeliness, and quality of document processing within the document management system (OnBase).
Process return mail, update guarantor status in Epic, and utilize available tools (e.g., Experian responses) to resolve accounts.
Prepare and distribute outbound payor correspondence to support claims processing, reimbursement, and appeals.
Identify and resolve issues related to document workflows and escalate as appropriate.
Maintain department supplies and support administrative functions as needed.
Perform all Credit Balances responsibilities, including identifying patient overpayments and processing refunds and redistributions in accordance with policies and procedures.
Review and analyze account histories to validate credit balances and ensure accurate resolution.
Prioritize and resolve escalated or complex refund and redistribution requests.
Reconcile refund activity, verify accuracy of transactions, and ensure proper documentation within the system.
Identify trends or discrepancies and escalate issues as appropriate.
Provide support in Cash Posting operations as needed to ensure all patient accounting balances are accurately received and posted.
Assist with reconciliation of payments, adjustments, and transactions to maintain accuracy of patient accounts.
Identify posting discrepancies and collaborate with team members to resolve issues in a timely manner.
Demonstrate increased independence in managing daily work, prioritizing tasks, and meeting productivity and quality standards.
Serve as a resource to Level I team members for questions related to processes, workflows, and systems.
Participate in cross-training across functional areas to support operational flexibility.
Ensure compliance with departmental policies, regulatory requirements, and confidentiality standards.
Performs Other Duties as Assigned