Revenue Cycle Specialist II Hybrid

University Hospitals•Shaker Heights, OH

3d•Hybrid

About The Position

The Revenue Cycle Specialist II submits and resolves medical claims of moderate to high complexity for inpatient and outpatient services across wholly owned facilities and physician entities. The role requires staying current with governmental and third-party billing, follow-up, and appeal requirements, while following internal and external policies to ensure compliant billing and claims follow-up. The specialist uses worklists and multiple system applications to analyze account balances, update patient information, research outstanding accounts receivable, and collect payment for services rendered. The position communicates with patients, insurance companies, physicians, staff, management, and other internal and external customers to resolve inquiries and claims issues in a high-volume environment. It also contributes to claims-resolution analysis and process improvements, participates in team meetings and staff training, leads special projects, and meets team productivity and quality standards. The specialist must protect patient confidentiality and securely maintain Protected Health Information (PHI), following applicable training, policies, and the UH Code of Conduct.

Requirements

High school equivalent or GED required.
At least 1 year of medical billing or claims experience required.
Working knowledge of claim submission using UB04/HCFA 1500 and third-party payers required.
Proficiency in procedural and ICD-10 coding required.
Basic knowledge of medical billing terminology required.
Detail-oriented and organized, with analytical and problem-solving ability.
Strong client service, communication, and relationship-building skills.
Ability to work independently and as a team player in a fast-paced environment.
Strong written and verbal communication skills.
Ability to use PCs, Microsoft Office (including Word, Excel, and Outlook), and general office equipment such as printers, copy machines, and fax machines.
Ability to meet the stated physical demands, including frequent repetitive motions and eye/hand/foot coordination, occasional standing, walking, handling and grasping, and rare lifting, carrying, pushing, pulling, climbing, and other listed movements.
Travel requirement stated as “10%25.”

Nice To Haves

Associate's degree preferred.
Bachelor's degree preferred.
Experience with medical billing software preferred.

Responsibilities

Respond to requests from management, staff, or physicians in a timely and appropriate manner.
Maintain patient and physician confidentiality and professionalism.
Follow department policies and procedures to ensure accurate and timely claim resolution.
Communicate by telephone, form letters, email, or internal correspondence to resolve patient inquiries and insurance issues.
Attend and participate in team meetings.
Use worklists to review and analyze account balances and collect payment for medical services rendered.
Use multiple system applications to review and update patient information and research and resolve outstanding accounts receivable balances.
Assist with claims-resolution analysis and provide feedback to management on solutions and process improvements.
Follow up with insurance companies to ensure appropriate claim payment, resolve denials, correct claims, and appeal claims.
Act as a liaison with internal and external customers to assist with claims and receivables resolution in a high-volume environment.
Document accounts clearly and concisely in accordance with departmental procedures.
Review and respond to correspondence and inquiries.
Meet and exceed team productivity and quality standards.
Lead special projects.
Participate in staff training.
Review complex claims issues, resolve them, and recommend process improvements.
Perform other duties as assigned.
Comply with all policies and standards and requirements for safely and securely maintaining patients' Protected Health Information.