Revenue Cycle Specialist One

Emory Healthcare•Tucker, GA

5d•$22 - $27

About The Position

The Revenue Cycle Specialist is versatile in all aspects of the revenue cycle and resolves patient claims. The role updates demographic and insurance information, collects and follows up on accounts before, during, and after admission and discharge, and communicates Emory Healthcare's financial policies to patients. It identifies patients who need financial counseling and provides information about financial assistance resources. The specialist verifies, researches, and completes paperwork and forms for billing claims, advocates for patients throughout the account cycle, and resolves financial issues. The role maintains knowledge of insurance, reimbursement, account reconciliation, referrals, authorizations, and account follow-up. It reviews and operationalizes managed care contracts and payer requirements, including requirements related to pre-certification, split claims, payment analysis, and complex payment variances. The work may cover transplant, hospice, infusion, rehabilitation, and Center of Excellence patients, and may require knowledge of transplant care standards and donor and recipient phases. The specialist supports departmental workflows and leadership, reports issues and opportunities to improve quality and revenue and reduce denials, assists with training new staff, answers employee questions, and works with management to implement departmental objectives. The position requires independent work, substantial phone and computer use, and detailed knowledge of applicable electronic medical records, patient accounts, payer systems, and financial tools. Relevant education sessions and payer forums should be attended as appropriate.

Requirements

Bachelor's degree and two years of relevant experience, or an equivalent combination of education and experience.
Ability to work independently.
Excellent verbal, written, analytical, and interpersonal communication skills.
Professionalism in all circumstances.
Strong organizational and problem-solving skills, including the ability to use tools, analyze situations, research data, and resolve issues or formulate decisions.
Detailed knowledge of applicable electronic medical records, patient accounts, payer systems, and financial tools.
Knowledge of insurance and payer requirements, reimbursement, account reconciliation, referrals, authorizations, and account follow-up.
Ability to review and understand managed care contracts and billing and reimbursement considerations for complex claims.
Ability to use a computer and phone extensively.
Physical ability to lift and carry up to 25 pounds; occasional to frequent standing and walking; occasional sitting; and close eye work such as computer use, typing, reading, and writing.

Responsibilities

Update patient demographic and insurance information for accuracy.
Collect and follow up on assigned accounts before, during, or after admission and discharge.
Communicate Emory Healthcare's financial policies to patients.
Identify patients requiring financial counseling and provide information about financial assistance resources.
Verify, research, and complete paperwork and forms to bill claims for reimbursement.
Serve as a patient advocate throughout the account cycle and identify and resolve patient financial issues.
Maintain knowledge of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure claim reimbursement.
Support departmental workflow as needed and identify and notify leadership of issues, initiating appropriate action for resolution.
Serve as a point person for employee questions and assist with training and development of new staff.
Support quality improvement by reporting problems, concerns, and opportunities to increase revenue and decrease denials through quality assurance processes.
Review, analyze, and operationalize managed care contracts and payer requirements to maximize reimbursement, including complex claims and payment variances.
Provide liaison and educational services in support of standards of care for applicable patient populations, including transplant populations where relevant.
Work with management to formulate and implement departmental objectives that enhance workflow.
Attend education sessions and insurance payer forums as appropriate.
Perform other duties as assigned or required pertinent to the revenue cycle.