Senior Revenue Cycle Specialist

Stony Brook University-posted 28 days ago
Full-time • Mid Level
East Setauket, NY
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At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as an operational leader in the Hospital's Business Office to analyze, track, and pursue the payment of under-paid and denied accounts receivable. Successful candidates will have a bachelor's degree and three years' healthcare revenue cycle experience or in lieu of degree 5 plus years' experience in an Acute Care Hospital Revenue Cycle or Patient Accounting Department resolving hospital Managed Care payment variances and/or denials.

  • Develops staff work listing logic/strategy and claims resolution work flows.
  • Educates and trains new staff regarding departmental/unit policy and procedure, including Managed Care Contracts.
  • Monitors work queues and staff productivity to ensure work volumes and staffing are aligned.
  • Audits staff work; provide education on best practice.
  • Supervises junior staff. Completes employee performance programs and evaluations, scheduling and timesheets.
  • Analyzes and identifies claim payment issues, patterns, and root cause; tracks and pursues un-timely, under-paid and denied accounts.
  • Collaborates on denials prevention initiatives.
  • Liaises with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials.
  • Collaborates with the Managed Care Department, HIM and Patient Accounting leadership to address payment issues and resolve at risk/high dollar accounts.
  • Analyzes new contracts and works with Contract Management system support to trouble-shoot contract rates and terms.
  • Participates in Joint Operating Calls (JOC) with insurance payers.
  • Monitors medical record request, correspondence distribution and scanning processes, volume, and trends.
  • Assists in maintaining and creating payer report cards, claims tracking and management reporting as requested.
  • Assists management reporting and special projects as requested.
  • Bachelor's degree and three years' healthcare revenue cycle experience,
  • OR in lieu of a Degree 5 years of Healthcare Revenue Cycle experience resolving hospital Managed Care payment variances and denials.
  • Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies.
  • Expert knowledge of third party reimbursement methodology and associated healthcare claim drivers.
  • Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i).
  • Experience working with CPT/HCPCs and ICD-10 codes.
  • Experience working with Cerner Invision Patient Accounting.
  • Proficiency in MS Office Suite. Including: Excel, Word.
  • Excellent written and verbal communication skills.
  • Experience working within Cerner Contract Management, Epic or equivalent including experience in validating the configuration and build of contracts.
  • Medical Coding Certification through the American Academy of Professional Coders (AAPC).
  • and/or the American Health Information Management Association (AHIMA.)
  • Proficiency with MS Access, Visio and/or PowerPoint.
  • Knowledge of SQL or Database Queries.
  • Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems.
  • Proficiency with SAP Business Objects / Crystal Reports.
  • Proficiency with visualization software (Tableau, MS Power BI, etc.).
  • SBUH provides generous leave, health plans, and a state pension that add to your bottom line.
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