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. ESSENTIAL FUNCTIONS & 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.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
