Senior Rep-Denials-Revenue Cycle-Hybrid

Mayo Clinic • Rochester, MN

7d • Hybrid

About The Position

The Senior Revenue Cycle Rep is an experienced position within the Mayo Clinic enterprise Revenue Cycle team. This position will be responsible for ensuring accurate and appropriate actions to ensure payment integrity for Mayo Clinic services. This requires deep understanding of revenue cycle and payer policies and the ability to resolve complex issues. This position will be responsible for revenue cycle activities that require deep insight into claim processes and requiring comprehensive interpretation and understandings of payer contracts and industry standards. Incumbents must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, and attention to detail. It is expected that staff are self-motivated, self-directed and highly organized and agree to promote a productive, collegial workplace. Staff should have the ability to prioritize work and handle a variety of tasks simultaneously. Belief in the mission and strong ethical conduct is essential. The position will require assertive communication with third party payer representatives and effective communication and coordination with necessary internal areas to ensure favorable outcomes for patients and the organization. In addition, the Senior Revenue Cycle Rep will take initiative to continuously learn within assigned job function to support progressive responsibility. This position will be responsible for interpreting data, drawing conclusions, review findings and provide recommendations for improvements. Maintain a growing knowledge of applicable State, Federal and local laws/regulations, correct billing and coding requirements including industry specific data such as modifiers, CPT and ICD-10 coding. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. Consistently document within the patient accounting system all actions and encounters leveraging necessary standard codes. Participates in special projects and other duties as directed by the Supervisor.

Requirements

• High School Diploma or GED and a minimum of 5 years of relevant healthcare, medical billing (hospital and/or professional), financial clearance or denial management experience.
• Advanced knowledge of medical billing and collections processes required.
• Advanced financial and mathematical competencies are essential.
• Analytical, problem-solving, and decision-making skills are essential.
• Advanced computer/keyboarding skills.
• Must maintain regular and acceptable attendance; may be required to work OT.

Nice To Haves

• Associates degree or higher preferred.
• Bachelor’s degree and a minimum of 1 year of relevant healthcare, medical billing (hospital and/or professional), financial clearance or denial management experience.
• Competence and experience with Epic is preferred.
• Advanced knowledge of healthcare terminology preferred.
• Advanced knowledge of multiple payers preferred.
• Healthcare Financial Management Association (HFMA) Certification Preferred.
• Excellent written and verbal communication skills, i.e. English, including proper phone etiquette.

Responsibilities

• Ensuring accurate and appropriate actions to ensure payment integrity for Mayo Clinic services.
• Resolving complex issues related to revenue cycle and payer policies.
• Interpreting data, drawing conclusions, reviewing findings, and providing recommendations for improvements.
• Maintaining knowledge of applicable State, Federal and local laws/regulations, correct billing and coding requirements including industry specific data such as modifiers, CPT and ICD-10 coding.
• Adhering to quality assurance guidelines and established productivity standards.
• Documenting all actions and encounters within the patient accounting system.
• Participating in special projects and other duties as directed by the Supervisor.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED