Finance - Revenue Cycle Specialist

ArchWell Health•Nashville, TN

1d•Onsite

About The Position

The Revenue Cycle Specialist provides support of all aspects of Revenue Cycle Services and is responsible for supporting the efficiency and effectiveness of revenue cycle operations including vendor and MA plan partner collaboration to meet service level agreements and key performance indicators. The Revenue Cycle Specialist will assist in developing new and emerging approaches for our business processes, projects, and initiatives which will include deliverables that drive financial profitability and meet or exceed margin thresholds. This position reports to the Revenue Cycle Director and will be responsible for supporting the day-to-day revenue cycle operations. This role will collaborate with our clinical, operations and IT teams to drive results. At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life. Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

Requirements

Deep understanding of revenue cycle functions and requirements in a complex, multi-state setting
Possess excellent communication skills, both written and oral
Proven performance results, decision making and judgement
Experience with external vendors and outsourced billing staff
Associate’s degree required
3+ years of revenue cycle experience in physician office setting
Coding certification (CPC, COC, CCS, CCA, CPB, CBCS) required or completed within 6 months of hire

Nice To Haves

Extensive knowledge of eClinicalWorks
Experience with capitated reimbursement models

Responsibilities

Support rapidly growing outsourced billing and coding teams, and identify ideal operating process flows as needed for scalability and optimization
Assist in developing strong internal processes and documented workflows in support of the revenue cycle, and ensure appropriate integration with field operations
Continually seek ways to improve the delivery and support of revenue cycle activities and provide recommendations for changes to proactively identify process improvement and eliminate barriers to success
Provide eligibility and insurance verification support to centers
Investigate and resolve issues related to patient coverage, effective dates, and missing enrollment information by contacting insurance companies, patients, and other departments.
Maintain accurate patient demographic and insurance data in EHR
Confirm member co-pays, deductibles, coinsurance are accurately captured and collected
Support all aspects of coding and billing to ensure legal and compliance standards
Conduct internal audits of billing and coding practices.
Provide regular cadence reporting to compliance.
Ensure adherence to CMS and payer specific regulations
Assist in building strong relationships with key stakeholders including finance and accounting, IT and field clinical operations.
Assist in the development of training materials and deliver in person training as needed to our field personnel as we open new centers
Occasional travel will be required (5-10%)