Revenue Cycle Specialist – Revenue Recovery and Retention

SBHU•East Setauket, NY

About The Position

At Stony Brook Medicine the Revenue Cycle Specialist will work within the Revenue Recovery and Retention Unit of the hospital’s business office to analyze, track and pursue the payment of Managed Care under-paid and denied accounts receivable. Duties of an Revenue Cycle Specialist may include the following, but are not limited to\: Analyze Managed Care payment variances; track and pursue under-paid and denied accounts. Assist in validating Contract Management system changes including encounter qualifiers and payment rates and methodologies. Assist in educating new staff regarding Managed Care Contracts, CM System and Denials & Appeals process. Provide operational support for Senior Revenue Cycle Specialist as required. Provide analysis and reporting as needed.

Requirements

Bachelor's Degree and at least 2 years of healthcare revenue cycle experience
In Lieu of a degree, at least 4 years of healthcare revenue cycle experience
Working knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies
Working knowledge of third party reimbursement methodology and drivers
Working knowledge of hospital inpatient and outpatient billing requirements (UB-04, 837i)
Experience working with CPT/HCPCs and ICD-10 codes
Proficiency with an Acute Care Hospital Contract Management system
Proficiency in MS Office Suite including Excel and Word
Excellent written and verbal communication skills

Nice To Haves

B.S. Accounting or Finance, Health Information Management, Health Administration, Computer Science or related field
Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA)
Experience in revenue recovery within Cerner Contract Management and Optum Payment Integrity Compass
Experience building contracts and modeling revenue in a Hospital Contract Management System
Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems
Experience working with Cerner Invision Patient Accounting

Responsibilities

Analyze Managed Care payment variances
Track and pursue under-paid and denied accounts
Assist in validating Contract Management system changes including encounter qualifiers and payment rates and methodologies
Assist in educating new staff regarding Managed Care Contracts, CM System and Denials & Appeals process
Provide operational support for Senior Revenue Cycle Specialist as required
Provide analysis and reporting as needed