Revenue Cycle Specialist
About The Position
Baptist Health is looking for a Revenue Cycle Specialist to join their team. This is a remote work position that requires residency in KY or IN Research denials from all commercial and governmental payors. Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains pre-determinations, prior authorizations, and retro authorizations when required by payor. Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines. Recovery efforts include but are not limited to written letter, email, web site, and telephonic communication. If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now! Baptist Health is an Equal Employment Opportunity employer.
Requirements
- Bachelor's Degree in related field, Practical Nurse License, or Coding Certification with two years healthcare experience required.
- In lieu of Bachelor's degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care.
- Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts.
- Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.
Responsibilities
- Research denials from all commercial and governmental payors.
- Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing.
- Obtains pre-determinations, prior authorizations, and retro authorizations when required by payor.
- Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines.
- Recovery efforts include but are not limited to written letter, email, web site, and telephonic communication.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
1,001-5,000 employees
