Senior Revenue Cycle Specialist

Position Summary:

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.

Job Responsibilities may include the following, but are not limited to:

• 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.
  
   

Qualifications:

Required:

• 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.

Preferred:

• 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.).

Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.
 

Special Notes:   Resume/CV should be included with the online application.