Insurance Denial Root Cause Specialist role

RAYUS Radiology•St. Louis Park, MN

2d•$22 - $32•Onsite

About The Position

RAYUS Radiology is looking for a Revenue Process Specialist to join their team. They are challenging the status quo by shining light on radiology and making it a critical first step in diagnosis and proper treatment. As a Revenue Process Specialist, you will perform process quality analysis on revenue cycle management processes to optimize financial outcomes, increase efficiency and prevent errors that result in re-work. You will collaborate with RCM Leadership and Market Operations on implementation of policies & procedures to drive consistency and improvement in overall revenue cycle operations. You will provide support on transformational initiatives impacting RCM functions including process documentation, test preparation and execution, training & change management. The scope of processes to be analyzed includes patient registration, scheduling, insurance, time-of-service collections, coding, billing, payment application, accounts receivable, claims & contract management.

Requirements

High school diploma or equivalent
3 years’ medical office and medical insurance policy experience
Microsoft Office Suite experience

Nice To Haves

Bachelor’s degree
1 year front office patient access services experience

Responsibilities

Collaborates with reporting & analytics team to obtain appropriate data for analysis, research and distribution
Identifies trends and performs root cause analysis
Collaborates with the Manager/Supervisor of the process owning team(s) to identify solutions in efforts to maximize productivity and minimize any financial impact
Develops, researches, and writes new policies to support business initiatives
Researches workflow, operational, and system impacts
Manages approved policies and procedures through end-to-end lifecycle
Analyzes recurring problems and formulates plans to address each, coordinating efforts with others as required
Corresponds regularly with markets on education and assists with process improvement implementation for upstream processes (patient registration, coding, etc.), based on analysis
Facilitates reoccurring continued education training sessions for the markets on revenue cycle related front office processes
Assists in updating processes and procedures to maintain standards for patient registration, coding and appropriate documentation
Delivers messages in a consistent format that provides markets visibility into trending issues impacting revenue, proposed improvements and identified outcomes
Serves as primary point of contact for fielding market questions and requests regarding upstream processes
Works with Process Improvement & Training Manager to identify process improvement opportunities
Identifies the responsible working group of subject matter experts (SME) and collaborates with SME group to gather information, document current state business processes, and identify opportunities for improvement
Works collaboratively with management and SMEs to understand desired performance and implement a future state process
Participates in departmental quality improvement processes
Conducts compliance training for new market acquisitions, new hires as needed, including by not limited to eligibility, patient estimations, time of service collections and end of day reconciliation
Assesses learning needs and develops appropriate training solutions for new and existing processes; focusing on creating the best possible patient experience
Conducts ongoing analysis of training effectiveness; updates tools and explores new materials for learners as needed
Partners with Human Resources on the launch of new RCM related online trainings
Monitors completion of RCM related online trainings, sending reminders to participants and providing management with status updates
Takes action to stay abreast of current and evolving learning trends, instructional methods/techniques and emerging technologies.
Identifies common trends and prepares and delivers system tips to end users
Completes other tasks and projects as assigned