Revenue Cycle Specialist

JOB SUMMARY 

Responsible for managing patient account staff in processing accounts and working with designated payers to ensure proper reimbursement.  Ownership of assigned Payer AR and all activities required to identify underpayments and prepare accounts for escalation to the payers in order to drive account resolution.  Resolve claims in a timely manner by completing appeals as needed or driving materials and accounts through the Plan Manager to the Payer.  

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Manages the aging of accounts receivable by trending and analyzing the A/R, and through communication with the payers/managers. Monitors collection processes to determine cash flow improvement opportunities.
• In depth knowledge of applicable contracts.  Continual QA and analysis of underpayment risk areas to ensure audit accuracy.  Ensure compliance with state and federal laws and regulations.  Maintains a thorough understanding of health insurance and government programs, where necessary.
• Prepare escalation packages, pre demand packages and any necessary Payer materials with corroborating contract support for submission to the Manager and ultimately the Payer.
• Monitor payer memos and create communication on changes to support teams
• Respond to claim denials from insurance companies to ensure contractual payment of submitted claims and Resubmit claims and write appeals to insurance companies
• Collaboration with various support teams on identified issues (includes issue logs).  

SUPERVISORY RESPONSIBILITIES 

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

No. Direct Reports (incl, titles)     Patient Acct Reps, Sr Patient Acct Reps, Lead Patient Acct Reps, and Patient   Acct Supervisors

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Advanced knowledge of healthcare A/R
• Excellent working knowledge of Patient Financial Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors (i.e., Medicare regulations and compliance; HIPAA)
• Proficient in Microsoft Office (Word and Excel) 
• Advanced writing skills 
• Ability to provide advanced customer service
• Ability to plan and implement process improvements
• Ability to train and coach staff
• Ability to multi-task
• Strong leadership and organizational skills
• Proficient in building a strong team to meet performance goals
• Very good written and verbal communication skills
• Strong interpersonal skills
• Strong technical skills, including PC and MS Office Suite knowledge

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Bachelor’s degree preferred in Healthcare Administration, Business or related area or equivalent experience. MBA/CPA preferred
• 2-4  years experience in Healthcare Administration or Business Office 

CERTIFICATES, LICENSES, REGISTRATIONS

• HFMA-Patient Accounts or Hospital Accounting Certification encouraged

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit and work at a computer terminal for extended periods of time

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential function