Revenue Cycle Specialist

Emory Healthcare•Atlanta, GA

18h

About The Position

JOB DESCRIPTION: Versatile in all aspects of the Revenue Cycle through Resolution of all patient claims. This position updates demographic and insurance information for accuracy on all patients. Collects and follows up on all accounts assigned prior to, during or after admission and discharge. Communicates EHC's financial policies to all patients. Identifies patients who require financial counseling intervention; provides information regarding resources for patients who need financial help after discharge and/or during collections and follow up activities. Verifies, researches and completes all paperwork and forms to bill all types of claims for reimbursement. Serves as a patient advocate during the cycle of the account. Assist with departmental workflow as needed. Identifies and notifies leadership of issues and initiates appropriate action for resolution. Serves as point person for employee questions. Maintains thorough understanding of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure reimbursement of claims. Provides support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials through the quality assurance process. Assists in training and development of new staff members. Must be able to review and operationalize contracts as it relates to billing and reimbursement of complex claims. The position may be responsible for understanding and maintaining knowledge of standard for care of specific transplant population and the phases of donors and recipients. Provides liaison and educational services in support of standards. Identifies and resolves financial issues relating to all patients. Problem solving skills are required as the applicant must be able to use various tools, analyze the situation, research data and resolve and/or formulate a decision. Works closely with Management in formulating and implementing departmental objectives toward enhancing the work flow of the department. This position requires heavy phone and computer usage, and a detailed knowledge of applicable EMRs, patient accounts, payer, and financial tools. Additionally, education sessions and insurance payor forums should be attended as appropriate. Specialist is required to review, analyze and understand the Managed Care Contracts and various aspects of patient care to maximize reimbursement. This includes but is not limited to transplants, hospice, infusions, rehab and Center of Excellence patients. Knowledge of payer requirements including pre-cert requirements, splitting of claims, analyzing payments, researching complex payment variances are critical for patient and/or account resolutions. The Revenue Cycle Specialist must be able to work independently. They must have excellent verbal, written, analytical and interpersonal communication skills. Professionalism must be maintained at all times regardless of circumstances. Organization skills are also very important. Other job duties as assigned pertinent to the Revenue Cycle. Performs other duties as required.

Requirements

Bachelors Degree with two years of relevant experience; OR any combination of equivalent education and experience.
Must be able to work independently.
They must have excellent verbal, written, analytical and interpersonal communication skills.
Professionalism must be maintained at all times regardless of circumstances.
Organization skills are also very important.
This position requires heavy phone and computer usage, and a detailed knowledge of applicable EMRs, patient accounts, payer, and financial tools.
Knowledge of payer requirements including pre-cert requirements, splitting of claims, analyzing payments, researching complex payment variances are critical for patient and/or account resolutions.
Problem solving skills are required as the applicant must be able to use various tools, analyze the situation, research data and resolve and/or formulate a decision.

Responsibilities

Versatile in all aspects of the Revenue Cycle through Resolution of all patient claims.
Updates demographic and insurance information for accuracy on all patients.
Collects and follows up on all accounts assigned prior to, during or after admission and discharge.
Communicates EHC's financial policies to all patients.
Identifies patients who require financial counseling intervention; provides information regarding resources for patients who need financial help after discharge and/or during collections and follow up activities.
Verifies, researches and completes all paperwork and forms to bill all types of claims for reimbursement.
Serves as a patient advocate during the cycle of the account.
Assist with departmental workflow as needed.
Identifies and notifies leadership of issues and initiates appropriate action for resolution.
Serves as point person for employee questions.
Maintains thorough understanding of insurance, payment reimbursement, account reconciliation, referrals, authorizations, and account follow-up to secure reimbursement of claims.
Provides support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials through the quality assurance process.
Assists in training and development of new staff members.
Must be able to review and operationalize contracts as it relates to billing and reimbursement of complex claims.
The position may be responsible for understanding and maintaining knowledge of standard for care of specific transplant population and the phases of donors and recipients.
Provides liaison and educational services in support of standards.
Identifies and resolves financial issues relating to all patients.
Works closely with Management in formulating and implementing departmental objectives toward enhancing the work flow of the department.
Specialist is required to review, analyze and understand the Managed Care Contracts and various aspects of patient care to maximize reimbursement.
Performs other duties as required.