Revenue Cycle Specialist I

Emory•Atlanta, GA

16h

About The Position

The Revenue Cycle Specialist I handles patient accounts throughout the revenue cycle, from updating demographic and insurance information to resolving claims and securing reimbursement. The role collects and follows up on accounts before, during, or after admission and discharge; communicates financial policies; identifies patients who may need financial counseling; and provides information about financial assistance resources. It verifies and completes claim paperwork, advocates for patients, and helps resolve financial issues. The specialist maintains knowledge of insurance, reimbursement, account reconciliation, referrals, authorizations, payer requirements, and account follow-up. The role reviews managed-care contracts and complex claims, researches payment variances, and works to maximize reimbursement for services that may include transplants, hospice, infusions, rehabilitation, and Center of Excellence care. It may also support transplant-related standards and provide liaison and educational services. The position supports departmental workflow and quality improvement, reports issues and opportunities to leadership, assists with training new staff, and serves as a resource for employee questions. It requires independent work, strong problem-solving and communication skills, organization, professionalism, and substantial phone and computer use. Other revenue-cycle duties may be assigned.

Requirements

Bachelor’s degree and two years of relevant experience, or an equivalent combination of education and experience.
Ability to work independently and use problem-solving skills to analyze situations, research data, and resolve issues or formulate decisions.
Excellent verbal, written, analytical, and interpersonal communication skills.
Professionalism in all circumstances and strong organizational skills.
Detailed knowledge of applicable electronic medical records, patient accounts, payer, and financial tools.
Ability to review and understand managed-care contracts, payer requirements, and complex billing and reimbursement matters.
Ability to use a phone and computer extensively.
Physical ability to lift and carry up to 25 pounds, with occasional to frequent standing and walking and occasional sitting.
Ability to perform close eye work, including computer use, typing, reading, and writing.

Responsibilities

Update demographic and insurance information for accuracy.
Collect and follow up on assigned accounts before, during, or after admission and discharge.
Communicate financial policies to patients and identify those needing financial counseling.
Provide information about financial assistance resources during discharge and collections or follow-up activities.
Verify, research, and complete paperwork and forms to bill claims for reimbursement.
Advocate for patients throughout the account cycle and identify and resolve patient financial issues.
Maintain knowledge of insurance, reimbursement, account reconciliation, referrals, authorizations, and account follow-up.
Review and operationalize contracts relating to billing and reimbursement of complex claims.
Review, analyze, and understand managed-care contracts and patient-care details to maximize reimbursement.
Research payer requirements, pre-certification requirements, split claims, payment analysis, and complex payment variances.
Support departmental workflow and notify leadership of issues, initiating appropriate action for resolution.
Report problems, concerns, and opportunities to improve revenue and reduce denials through quality assurance processes.
Assist leadership with quality improvement and departmental objectives and workflow implementation.
Serve as a point person for employee questions and assist with training and developing new staff.
Attend education sessions and insurance payer forums as appropriate.
For applicable transplant populations, maintain knowledge of standards of care and donor and recipient phases, and provide liaison and educational services.
Perform other revenue-cycle duties as assigned or required.