Revenue Cycle Specialist I

CERIS • Fort Worth, TX

3d • $19 - $29 • Remote

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.

Requirements

• Ability to work independently and use critical thinking.
• Detailed knowledge of pay reimbursement methodology for 
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
• Strong understanding of healthcare revenue cycle and claims reimbursement 
• MS Office includes Word, PowerPoint, Excel and Outlook, Windows operating system and Internet.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to deliver results in a fast paced and dynamic environment.
• Claims repricing, pricing configuration, or provider maintenance experience required
• 3+ years of relevant experience or equivalent combination of educations and work experience
• High School Diploma or equivalent required
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable

Responsibilities

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines
• Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims with precision
• Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners.
• Performs contract and reimbursement variance analysis.
• Analyzes claims data to identify contractual overpayments and billing errors.
• Assists department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources.
• Learns or remains current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing.
• Provides subject matter expertise on billing and coding guidelines and regulations as required by the department.
• Uses internal and external billing protocols and regulations for repricing bills at a cost savings to the customer.
• Identifies trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing.
• Establishes and maintains detailed knowledge and documentation of all analysis/data sources within the department.
• Analyzes all forms of Revenue Cycle transactions.
• Possesses the ability to run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders.
• Produces 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.
• Evaluates 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.
• Additional duties as assigned.

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, and paid time off.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees