Sr Revenue Cycle Specialist

SBHU•East Setauket, NY

5d•Onsite

About The Position

At Stony Brook Medicine, the Senior Revenue Cycle Specialist will act as operational lead in the Revenue Recovery and Retention Unit of the hospital’s business office working to analyze, track and pursue the payment of Managed Care 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 denials. Experience with a Hospital Contract Management system such as Cerner, Optum or Epic is strongly preferred.

Requirements

Bachelor’s degree and three years’ healthcare revenue cycle experience, or in lieu of degree, 5 years or more 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.

Nice To Haves

Experience working within Cerner Contract Management, Epic or equivalent including experience in validating the configuration and build of contracts.
Experience building contracts and modeling revenue in a Hospital Contract Management System.
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.).

Responsibilities

Lead Payer Joint Operating Calls (JOC).
Analyze payment variances; track and pursue under-paid and denied accounts.
Liaise with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials.
Track and trend denials, systemic underpayments.
Maintain JOC Trackers.
Analyze new contracts and work with Contract Management system support to configure contract rates and terms.
QA all Contract Management system changes including encounter qualifiers and payment rates and methodologies.
Develop staff work listing logic/strategy and claims resolution work flows.
Educate new staff regarding Managed Care Contracts, CM System and Denials and Appeals process.
Assist in maintaining and creating payer report cards, claims tracking and management reporting as requested.
Special projects, as assigned.