Revenue Cycle Specialist I

About the position

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. This is a remote position.

Responsibilities

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines
• Establish and maintain accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims
• Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners
• Perform contract and reimbursement variance analysis
• Analyze claims data to identify contractual overpayments and billing errors
• Assist department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources
• Learn or remain current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing
• Provide subject matter expertise on billing and coding guidelines and regulations as required by the department
• Use internal and external billing protocols and regulations for repricing bills at a cost savings to the customer
• Identify trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing
• Establish and maintain detailed knowledge and documentation of all analysis/data sources within the department
• Analyze all forms of Revenue Cycle transactions
• Run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders
• Produce daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period to ensure the integrity and accuracy of revenue cycle data
• Evaluate integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances
• Ensure strict confidentiality of all medical records, PHI, and PII
• Perform additional duties as assigned

Requirements

• Claims repricing, pricing configuration, or provider maintenance experience required
• 3+ years of relevant experience or equivalent combination of education and work experience
• High School Diploma or equivalent required
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable

Nice-to-haves

• Ability to work independently and use critical thinking
• Detailed knowledge of pay reimbursement methodology
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
• Strong understanding of healthcare revenue cycle and claims reimbursement
• Strong analytical and problem-solving skills
• Strong attention to detail and ability to deliver results in a fast-paced and dynamic environment
• Proficiency in MS Office including Word, PowerPoint, Excel and Outlook, Windows operating system and Internet

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off